Healthcare Provider Details

I. General information

NPI: 1215006986
Provider Name (Legal Business Name): SKYE D CAMP PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 04/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7360 GOOLSBY RD
MONTICELLO GA
31064-5280
US

IV. Provider business mailing address

7360 GOOLSBY RD
MONTICELLO GA
31064-5280
US

V. Phone/Fax

Practice location:
  • Phone: 678-986-7551
  • Fax: 706-468-9361
Mailing address:
  • Phone: 678-986-7551
  • Fax: 706-468-9361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT006436
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT006436
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: