Healthcare Provider Details

I. General information

NPI: 1417040932
Provider Name (Legal Business Name): KAREN P SKUDERIN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 N STATE ROAD 434 SUITE 405
ALTAMONTE SPRINGS FL
32714
US

IV. Provider business mailing address

995 N STATE ROAD 434 SUITE 405
ALTAMONTE SPRINGS FL
32714
US

V. Phone/Fax

Practice location:
  • Phone: 407-774-6421
  • Fax: 407-774-0984
Mailing address:
  • Phone: 407-774-6421
  • Fax: 407-774-0984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT2694
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: