Provider Demographics
NPI:1417272089
Name:SKOWRONSKI, JEFFREY (PT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:SKOWRONSKI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4602 BIG ROCK DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19802-1004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2401 PENNSYLVANIA AVENUE
Practice Address - Street 2:SUITE 111
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-1432
Practice Address - Country:US
Practice Address - Phone:302-655-8989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0002574225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG00716Medicare PIN
DE302719ZBSXMedicare PIN