Healthcare Provider Details

I. General information

NPI: 1821145822
Provider Name (Legal Business Name): CYNTHIA MARIE SKORUPPA PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13725 NORTHWEST BLVD
CORPUS CHRISTI TX
78410-5127
US

IV. Provider business mailing address

4729 CALALLEN DR
CORPUS CHRISTI TX
78410-4742
US

V. Phone/Fax

Practice location:
  • Phone: 361-767-7200
  • Fax:
Mailing address:
  • Phone: 361-241-4201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2053416
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: