Provider Demographics
NPI:1215489075
Name:SKURKA, DEAN (PT)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:
Last Name:SKURKA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4133 FOX RUN TRL
Mailing Address - Street 2:APT 3
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-3620
Mailing Address - Country:US
Mailing Address - Phone:513-405-5667
Mailing Address - Fax:
Practice Address - Street 1:6281 TRI RIDGE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-8345
Practice Address - Country:US
Practice Address - Phone:513-791-5766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH004529225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH004529OtherOHIO LICESNE