MEDICARE: ELAINE SKELTON PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	2538	NC

General Provider Information

NPI Number	:	1811155591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELAINE SKELTON PTA

Provider Business Mailing Address
First Line	:	1478 RIVER RD SE
Second Line	:
City	:	WINNABOW
State	:	NC
Zip	:	28479-5821
Country	:	US
Telephone Number	:	910-383-2023
Fax Number	:	910-383-2023

Provider Business Practice Location Address
First Line	:	1478 RIVER RD SE
Second Line	:
City	:	WINNABOW
State	:	NC
Zip	:	28479-5821
Country	:	US
Telephone Number	:	910-383-2023
Fax Number	:	910-383-2023

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2008
Last Update Date	:	05/29/2008

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