Provider Demographics
NPI:1437691235
Name:SKON, CHRISTINA NICOLE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:NICOLE
Last Name:SKON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:CHRISTINA
Other - Middle Name:NICOLE
Other - Last Name:HASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14 MARTINSBURG RD APT C
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-4159
Mailing Address - Country:US
Mailing Address - Phone:740-817-0895
Mailing Address - Fax:
Practice Address - Street 1:416 WOOSTER RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-1216
Practice Address - Country:US
Practice Address - Phone:740-397-9626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA010570225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant