Provider Demographics
NPI:1770590671
Name:SKYLINE PHYSICAL THERAPY, AQUATICS AND REHAB SPECIALISTS
Entity type:Organization
Organization Name:SKYLINE PHYSICAL THERAPY, AQUATICS AND REHAB SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOFFINDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:877-474-3424
Mailing Address - Street 1:3915 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-1957
Mailing Address - Country:US
Mailing Address - Phone:877-552-2996
Mailing Address - Fax:262-657-7190
Practice Address - Street 1:5761 E BROWN RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-4400
Practice Address - Country:US
Practice Address - Phone:877-474-3424
Practice Address - Fax:480-984-5750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5823225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty