Provider Demographics
NPI:1619925013
Name:SKELTON, CHRISTOPHER (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:SKELTON
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 1:1430 E LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-7343
Mailing Address - Country:US
Mailing Address - Phone:580-286-5160
Mailing Address - Fax:580-286-5162
Practice Address - Street 1:1430 E LINCOLN RD
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-7343
Practice Address - Country:US
Practice Address - Phone:580-286-5162
Practice Address - Fax:580-286-5162
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4514225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR71085780150OtherQUALCHOICE
AR5Y117Medicare ID - Type UnspecifiedMEDICARE
AR662725OtherHEALTHLINK
AR5Y117OtherBLUE CROSS BLUE SHIELD