Provider Demographics
NPI:1851878383
Name:HOMER, JACQUELINE SKONIECZKI (DPT)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:SKONIECZKI
Last Name:HOMER
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:SKONIECZKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50 CENTRAL ISLAND ST UNIT 402
Mailing Address - Street 2:
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-7386
Mailing Address - Country:US
Mailing Address - Phone:814-460-9245
Mailing Address - Fax:
Practice Address - Street 1:1049 ANNA KNAPP BLVD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3133
Practice Address - Country:US
Practice Address - Phone:843-881-3210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-27
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9206225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist