Provider Demographics
NPI:1013005800
Name:SKOGAN, LEE ROBERT (DPT)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:ROBERT
Last Name:SKOGAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 SUEZ CANAL LN
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-7507
Mailing Address - Country:US
Mailing Address - Phone:360-441-5380
Mailing Address - Fax:
Practice Address - Street 1:121 SUEZ CANAL LN
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-7507
Practice Address - Country:US
Practice Address - Phone:360-441-5380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000106382251G0304X, 2251X0800X
CA280982251X0800X, 2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic