Provider Demographics
NPI:1497162283
Name:SKOW, CARRIE AMANDA (DPT)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:AMANDA
Last Name:SKOW
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:AMANDA
Other - Last Name:SKOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:1498 E MAIN ST STE 109
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424-2204
Mailing Address - Country:US
Mailing Address - Phone:541-767-2750
Mailing Address - Fax:541-767-2751
Practice Address - Street 1:1498 E MAIN ST STE 109
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:OR
Practice Address - Zip Code:97424-2204
Practice Address - Country:US
Practice Address - Phone:541-767-2750
Practice Address - Fax:541-767-2751
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR60613225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR176240Medicare PIN