Healthcare Provider Details

I. General information

NPI: 1386578037
Provider Name (Legal Business Name): ABIGAIL LYN SKINNER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 FRANK SCOTT PKWY E
O FALLON IL
62269-7342
US

IV. Provider business mailing address

1810 JEWEL SISSON DR UNIT 205
BELLEVILLE IL
62223-3561
US

V. Phone/Fax

Practice location:
  • Phone: 618-624-7077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.039928
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: