Provider Demographics
NPI:1457414609
Name:SKEESICK, JENNIFER A (DPT, SCS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:SKEESICK
Suffix:
Gender:F
Credentials:DPT, SCS
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:MOODY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1551 LOMBARD LOOP RD
Mailing Address - Street 2:
Mailing Address - City:WAPATO
Mailing Address - State:WA
Mailing Address - Zip Code:98951-9685
Mailing Address - Country:US
Mailing Address - Phone:334-750-9174
Mailing Address - Fax:864-528-5701
Practice Address - Street 1:103 N MAIN ST
Practice Address - Street 2:STE 99
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-2796
Practice Address - Country:US
Practice Address - Phone:864-528-5728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11773225100000X
SC6348225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist