Provider Demographics
NPI:1285783084
Name:SKOUTELAS, L DAPHNE (PT)
Entity type:Individual
Prefix:MRS
First Name:L
Middle Name:DAPHNE
Last Name:SKOUTELAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LINA
Other - Middle Name:DAPHNE
Other - Last Name:SKOUTELAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2401 PENNSYLVANIA AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-1432
Mailing Address - Country:US
Mailing Address - Phone:302-655-8989
Mailing Address - Fax:
Practice Address - Street 1:2401 PENNSYLVANIA AVE STE 112
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-1432
Practice Address - Country:US
Practice Address - Phone:302-655-8989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0001712225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist