Provider Demographics
NPI:1518458546
Name:SKYRIOTIS, THESPINA S (PTA)
Entity Type:Individual
Prefix:
First Name:THESPINA
Middle Name:S
Last Name:SKYRIOTIS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8949 W PROSPECTOR DR
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-7776
Mailing Address - Country:US
Mailing Address - Phone:602-460-2855
Mailing Address - Fax:
Practice Address - Street 1:20522 E SUPERSTITION DR
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-9763
Practice Address - Country:US
Practice Address - Phone:602-460-2855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPTA-013748225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant