MEDICARE: TIMOTHY STEPHEN SKARADA PT

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	225100000X	Physical Therapist	PT010099L	PA
2	225100000X	Physical Therapist	DAPT000025	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	650021206	OTHER	PA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	027967	OTHER	PA	HIGHMARK

General Provider Information

NPI Number	:	1871588566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY STEPHEN SKARADA PT

Provider Business Mailing Address
First Line	:	300 E PLANK RD
Second Line	:
City	:	ALTOONA
State	:	PA
Zip	:	16602-4154
Country	:	US
Telephone Number	:	814-941-7708
Fax Number	:	814-941-7715

Provider Business Practice Location Address
First Line	:	1 HOSPITAL DR
Second Line	:
City	:	TYRONE
State	:	PA
Zip	:	16686-1810
Country	:	US
Telephone Number	:	814-684-6309
Fax Number	:	814-684-6312

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

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	02/25/2013

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