Healthcare Provider Details

I. General information

NPI: 1417272089
Provider Name (Legal Business Name): JEFFREY SKOWRONSKI PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2010
Last Update Date: 12/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 PENNSYLVANIA AVENUE SUITE 111
WILMINGTON DE
19806-1432
US

IV. Provider business mailing address

4602 BIG ROCK DR
WILMINGTON DE
19802-1004
US

V. Phone/Fax

Practice location:
  • Phone: 302-655-8989
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0002574
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: