Provider Demographics
NPI:1689656555
Name:SKINNER, PAULA C (RPT)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:C
Last Name:SKINNER
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3B S LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-6407
Mailing Address - Country:US
Mailing Address - Phone:650-583-5420
Mailing Address - Fax:650-583-1398
Practice Address - Street 1:3B S LINDEN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-6407
Practice Address - Country:US
Practice Address - Phone:650-583-5420
Practice Address - Fax:650-583-1398
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOO6510PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ31480ZMedicare ID - Type Unspecified