Provider Demographics
NPI:1346390358
Name:SKURKA, PAULA ANN (MSPT, ATCL, CSCS)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:ANN
Last Name:SKURKA
Suffix:
Gender:F
Credentials:MSPT, ATCL, CSCS
Other - Prefix:MISS
Other - First Name:PAULA
Other - Middle Name:A
Other - Last Name:DOERING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSPT, ATCL, CSCS
Mailing Address - Street 1:8558 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7032
Mailing Address - Country:US
Mailing Address - Phone:219-392-7084
Mailing Address - Fax:219-703-6854
Practice Address - Street 1:1545 W US HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-1562
Practice Address - Country:US
Practice Address - Phone:219-836-5381
Practice Address - Fax:219-836-4466
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007558A225100000X
IN0699026982255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN35-2091369Medicare UPIN
IN199230CMedicare ID - Type Unspecified