Healthcare Provider Details

I. General information

NPI: 1659568574
Provider Name (Legal Business Name): KATHERINE E SKIBISKI PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 10/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 N HOSPITAL DR SUITE H
FULTON MO
65251-2535
US

IV. Provider business mailing address

850 N HOSPITAL DR SUITE H
FULTON MO
65251-2535
US

V. Phone/Fax

Practice location:
  • Phone: 573-642-8541
  • Fax: 573-642-8500
Mailing address:
  • Phone: 573-642-8541
  • Fax: 573-642-8500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2007023013
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: