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General NPI Number Information
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NPI Number | 1134113111
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Entity Type | Individual
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Provider Name | CAROLYN RAE SKINNER-SANDORA PT
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Gender | Female
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Dates
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Enumeration Date | 09/07/2005
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Last Update Date | 01/21/2015
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Provider Practice Location Address
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Address Line | 12341 NW 18TH ST
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City | PLANTATION
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State | FL
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Zip | 33323-2122
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Country | US
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Telephone | 954-478-4648
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Fax | 954-530-5694
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Provider Business Mailing Address
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Address Line | 3273 RIDGE TRCE
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City | DAVIE
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State | FL
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Zip | 33328-7149
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Country | US
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Telephone | 954-326-0128
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT6209
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License Number State | FL
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