Healthcare Provider Details

I. General information

NPI: 1346390358
Provider Name (Legal Business Name): PAULA ANN SKURKA MSPT, ATCL, CSCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAULA A DOERING MSPT, ATCL, CSCS

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 W US HIGHWAY 30
SCHERERVILLE IN
46375-1562
US

IV. Provider business mailing address

8558 BROADWAY
MERRILLVILLE IN
46410-7032
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-5381
  • Fax: 219-836-4466
Mailing address:
  • Phone: 219-392-7084
  • Fax: 219-703-6854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05007558A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number069902698
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: