Provider Demographics
NPI:1992180368
Name:SKORUPPA, DANA (PTA)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:SKORUPPA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-5134
Mailing Address - Country:US
Mailing Address - Phone:970-353-3370
Mailing Address - Fax:970-353-9347
Practice Address - Street 1:1700 18TH AVE
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-5134
Practice Address - Country:US
Practice Address - Phone:970-353-3370
Practice Address - Fax:970-353-9347
Is Sole Proprietor?:No
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013634225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant