Provider Demographics
NPI:1205913670
Name:SKELTON, SABRINA (MPT)
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:
Last Name:SKELTON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 S LOCUST ST
Mailing Address - Street 2:STE 5
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-5789
Mailing Address - Country:US
Mailing Address - Phone:575-521-4188
Mailing Address - Fax:575-521-3668
Practice Address - Street 1:2404 S LOCUST ST
Practice Address - Street 2:SUITE 5
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-5789
Practice Address - Country:US
Practice Address - Phone:505-521-4188
Practice Address - Fax:505-521-3668
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2857225100000X, 2251E1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM70031380Medicaid
NMNM00Q436OtherBCBS NM
NM349703901Medicare PIN