Provider Demographics
NPI:1811155591
Name:SKELTON, ELAINE (PTA)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:SKELTON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1478 RIVER RD SE
Mailing Address - Street 2:
Mailing Address - City:WINNABOW
Mailing Address - State:NC
Mailing Address - Zip Code:28479-5821
Mailing Address - Country:US
Mailing Address - Phone:910-383-2023
Mailing Address - Fax:910-383-2023
Practice Address - Street 1:1478 RIVER RD SE
Practice Address - Street 2:
Practice Address - City:WINNABOW
Practice Address - State:NC
Practice Address - Zip Code:28479-5821
Practice Address - Country:US
Practice Address - Phone:910-383-2023
Practice Address - Fax:910-383-2023
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2538225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant