Provider Demographics
NPI:1679688907
Name:SKOOG, JEREMY WILLIAM (PT)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:WILLIAM
Last Name:SKOOG
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 1:9 TOY ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-3122
Mailing Address - Country:US
Mailing Address - Phone:864-251-5410
Mailing Address - Fax:864-236-4918
Practice Address - Street 1:9 TOY ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3122
Practice Address - Country:US
Practice Address - Phone:864-251-5410
Practice Address - Fax:864-236-4918
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5127225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist