Provider Demographics
NPI:1023153806
Name:SKINNER, KEITH WILLIAM (ATC)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:WILLIAM
Last Name:SKINNER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 STOKE PARK RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-2232
Mailing Address - Country:US
Mailing Address - Phone:610-882-2730
Mailing Address - Fax:
Practice Address - Street 1:256 COUNTY ROAD 513
Practice Address - Street 2:
Practice Address - City:GLEN GARDNER
Practice Address - State:NJ
Practice Address - Zip Code:08826-6430
Practice Address - Country:US
Practice Address - Phone:908-638-2199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000776002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer