Provider Demographics
NPI:1841315793
Name:SKALKO, THOMAS KENT (PHD, LRT)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:KENT
Last Name:SKALKO
Suffix:
Gender:M
Credentials:PHD, LRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1463 SADDLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-8298
Mailing Address - Country:US
Mailing Address - Phone:252-328-0018
Mailing Address - Fax:252-328-4642
Practice Address - Street 1:1 OGLESBY DRIVE
Practice Address - Street 2:ECU BELK ANNEX
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-4353
Practice Address - Country:US
Practice Address - Phone:252-328-0018
Practice Address - Fax:252-328-4642
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC771174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist