Provider Demographics
NPI:1356709752
Name:SKINNER, ARRAN
Entity type:Individual
Prefix:
First Name:ARRAN
Middle Name:
Last Name:SKINNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8604 47TH ST
Mailing Address - Street 2:APT 1S
Mailing Address - City:LYONS
Mailing Address - State:IL
Mailing Address - Zip Code:60534-1663
Mailing Address - Country:US
Mailing Address - Phone:708-781-3113
Mailing Address - Fax:
Practice Address - Street 1:8604 47TH ST
Practice Address - Street 2:APT 1S
Practice Address - City:LYONS
Practice Address - State:IL
Practice Address - Zip Code:60534-1663
Practice Address - Country:US
Practice Address - Phone:708-781-3113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160007277225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant