Provider Demographics
NPI:1689624165
Name:SKRAMSTAD, PAUL (PT)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:SKRAMSTAD
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:PO BOX 21150
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80308-4150
Mailing Address - Country:US
Mailing Address - Phone:303-840-9202
Mailing Address - Fax:303-840-8928
Practice Address - Street 1:10345 S PARK GLENN WAY
Practice Address - Street 2:STE. #220
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-3869
Practice Address - Country:US
Practice Address - Phone:303-840-9202
Practice Address - Fax:303-840-8928
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3108174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COY07668Medicare UPIN
COC528778Medicare ID - Type Unspecified