Provider Demographics
NPI:1265874226
Name:SKINNER, DEVIN MICHAEL ELLERY (ATC)
Entity type:Individual
Prefix:
First Name:DEVIN
Middle Name:MICHAEL ELLERY
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 1:406 GRAND AVENUE EXT
Mailing Address - Street 2:APT. 2
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214-6176
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:112 TIPPIN GYM
Practice Address - Street 2:CLARION UNIVERSITY
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214
Practice Address - Country:US
Practice Address - Phone:814-393-2456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-19
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer