Provider Demographics
NPI:1932697547
Name:SKINNER, LARRY EUGENE I
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:EUGENE
Last Name:SKINNER
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21283 ORONO RD
Mailing Address - Street 2:
Mailing Address - City:REED CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49677-8662
Mailing Address - Country:US
Mailing Address - Phone:971-235-9255
Mailing Address - Fax:
Practice Address - Street 1:618A S MITCHELL ST
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-2510
Practice Address - Country:US
Practice Address - Phone:800-252-2065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist