Healthcare Provider Details

I. General information

NPI: 1639656895
Provider Name (Legal Business Name): DANIELLE MARIE SKOPEK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2018
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9219 WATER ST
MONTAGUE MI
49437-9206
US

IV. Provider business mailing address

500 CROSS ST
BIG STONE CITY SD
57216-8237
US

V. Phone/Fax

Practice location:
  • Phone: 231-893-6655
  • Fax: 231-893-4902
Mailing address:
  • Phone: 605-541-1140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501018733
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: