Provider Demographics
NPI:1811903438
Name:SKAGGS, SANDRA JOY (PT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:JOY
Last Name:SKAGGS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:837 EASTERN BYP
Mailing Address - Street 2:STE A
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2569
Mailing Address - Country:US
Mailing Address - Phone:859-625-5986
Mailing Address - Fax:859-625-5987
Practice Address - Street 1:837 EASTERN BYP
Practice Address - Street 2:STE A
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2569
Practice Address - Country:US
Practice Address - Phone:859-625-5986
Practice Address - Fax:859-625-5986
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY002066225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY8700163200Medicaid
KY8700163200Medicaid