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General NPI Number Information
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NPI Number | 1306118385
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Entity Type | Individual
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Provider Name | SANDI SKAWSKI PTA
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Gender | Female
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Dates
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Enumeration Date | 02/06/2012
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Last Update Date | 02/06/2012
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Provider Practice Location Address
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Address Line | 129 E LAKE ST
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-1104
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Country | US
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Telephone | 630-295-8445
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Fax |
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Provider Business Mailing Address
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Address Line | 565 S FAIRVIEW AVE
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City | ELMHURST
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State | IL
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Zip | 60126-3732
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Country | US
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Telephone | 630-871-6161
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 160000149
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License Number State | IL
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