Healthcare Provider Details

I. General information

NPI: 1871588566
Provider Name (Legal Business Name): TIMOTHY STEPHEN SKARADA PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 02/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR
TYRONE PA
16686-1810
US

IV. Provider business mailing address

300 E PLANK RD
ALTOONA PA
16602-4154
US

V. Phone/Fax

Practice location:
  • Phone: 814-684-6309
  • Fax: 814-684-6312
Mailing address:
  • Phone: 814-941-7708
  • Fax: 814-941-7715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT010099L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberDAPT000025
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: