Provider Demographics
NPI:1407175375
Name:SKELTON, LORENA
Entity Type:Individual
Prefix:
First Name:LORENA
Middle Name:
Last Name:SKELTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LORENA
Other - Middle Name:
Other - Last Name:SUANES-POSADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:15245 SHADY GROVE ROAD
Mailing Address - Street 2:C-100
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850
Mailing Address - Country:US
Mailing Address - Phone:301-417-2652
Mailing Address - Fax:301-417-2653
Practice Address - Street 1:15245 SHADY GROVE ROAD
Practice Address - Street 2:C-100
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850
Practice Address - Country:US
Practice Address - Phone:301-417-2652
Practice Address - Fax:301-417-2653
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA3351225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant