Provider Demographics
NPI:1326594342
Name:SKINNER, AMBER (DPT)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:SKINNER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 LILAC DR
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67901-2058
Mailing Address - Country:US
Mailing Address - Phone:620-644-9110
Mailing Address - Fax:620-644-9220
Practice Address - Street 1:111 LILAC DR
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2058
Practice Address - Country:US
Practice Address - Phone:620-644-9110
Practice Address - Fax:620-644-9220
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-05494225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS11-05494OtherKS LICENSE