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General NPI Number Information
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NPI Number | 1275860694
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Entity Type | Individual
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Provider Name | COLLEEN SKOTNICKI PT
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Gender | Female
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Dates
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Enumeration Date | 11/05/2009
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Last Update Date | 12/21/2016
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Provider Practice Location Address
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Address Line | 23408 W APOLLO CT
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City | LAKE VILLA
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State | IL
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Zip | 60046-9638
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Country | US
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Telephone | 847-856-9014
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Fax |
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Provider Business Mailing Address
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Address Line | 1250 GOLDFINCH LN
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City | ANTIOCH
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State | IL
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Zip | 60002-6410
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Country | US
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Telephone | 847-977-7188
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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 | 070013436
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License Number State | IL
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