Healthcare Provider Details

I. General information

NPI: 1356709752
Provider Name (Legal Business Name): ARRAN SKINNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2016
Last Update Date: 02/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8604 47TH ST APT 1S
LYONS IL
60534-1663
US

IV. Provider business mailing address

8604 47TH ST APT 1S
LYONS IL
60534-1663
US

V. Phone/Fax

Practice location:
  • Phone: 708-781-3113
  • Fax:
Mailing address:
  • Phone: 708-781-3113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160007277
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: