Provider Demographics
NPI:1437329612
Name:SKINNER-DAVIS, LAURA JEAN (CMT)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:JEAN
Last Name:SKINNER-DAVIS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:JEAN
Other - Last Name:SKINNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2921 N NOTTINGHAM ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-1252
Mailing Address - Country:US
Mailing Address - Phone:703-241-8572
Mailing Address - Fax:703-241-8572
Practice Address - Street 1:5275 LEE HWY
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22207-1619
Practice Address - Country:US
Practice Address - Phone:703-532-4882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019005369225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist