Provider Demographics
NPI:1245857366
Name:SKOLNIK, KARLY MADISON (PTA)
Entity type:Individual
Prefix:
First Name:KARLY
Middle Name:MADISON
Last Name:SKOLNIK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KARLY
Other - Middle Name:MADISON
Other - Last Name:ADAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:2831 AIRWAYS BLVD STE 102A
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38132-1115
Mailing Address - Country:US
Mailing Address - Phone:901-348-0200
Mailing Address - Fax:
Practice Address - Street 1:2831 AIRWAYS BLVD STE 102A
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38132-1115
Practice Address - Country:US
Practice Address - Phone:901-348-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6928225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant