Provider Demographics
NPI:1558816041
Name:SKORUSA, SHEA (ATC, SCAT)
Entity Type:Individual
Prefix:
First Name:SHEA
Middle Name:
Last Name:SKORUSA
Suffix:
Gender:F
Credentials:ATC, SCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 BIRKDALE CIR
Mailing Address - Street 2:APARTMENT #33
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29154-6324
Mailing Address - Country:US
Mailing Address - Phone:904-651-7015
Mailing Address - Fax:
Practice Address - Street 1:2580 MCCRAYS MILL RD
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29154-6028
Practice Address - Country:US
Practice Address - Phone:803-481-4480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16692255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer