Provider Demographics
NPI:1558694299
Name:TONY SKORPUT, PA
Entity Type:Organization
Organization Name:TONY SKORPUT, PA
Other - Org Name:SKORPUT REHABILITATION & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:SKORPUT
Authorized Official - Suffix:JR
Authorized Official - Credentials:BSPT
Authorized Official - Phone:843-616-4670
Mailing Address - Street 1:121 WEST MAIN STREET
Mailing Address - Street 2:HEIRLOOM PLAZA, SUITES D & E
Mailing Address - City:LAMAR
Mailing Address - State:SC
Mailing Address - Zip Code:29069
Mailing Address - Country:US
Mailing Address - Phone:843-616-4670
Mailing Address - Fax:
Practice Address - Street 1:121 WEST MAIN STREET
Practice Address - Street 2:HEIRLOOM PLAZA, SUITES D & E
Practice Address - City:LAMAR
Practice Address - State:SC
Practice Address - Zip Code:29069
Practice Address - Country:US
Practice Address - Phone:843-616-4670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC318225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty