Provider Demographics
NPI:1477567477
Name:SKLENKA, DOUGLAS (PT)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:
Last Name:SKLENKA
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 1:5587 PINEHURST DR APT A
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-4346
Mailing Address - Country:US
Mailing Address - Phone:614-850-1476
Mailing Address - Fax:614-850-1478
Practice Address - Street 1:4821 ROBERTS RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-9496
Practice Address - Country:US
Practice Address - Phone:614-850-1476
Practice Address - Fax:614-850-1476
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT010841225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSK4140414Medicare PIN
OHSK4140413Medicare PIN