Provider Demographics
NPI:1962693994
Name:SKINNER, TRUDY MICHELLE (PT)
Entity type:Individual
Prefix:MRS
First Name:TRUDY
Middle Name:MICHELLE
Last Name:SKINNER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 PRINTERS PKWY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-6100
Mailing Address - Country:US
Mailing Address - Phone:719-577-4104
Mailing Address - Fax:719-575-0872
Practice Address - Street 1:155 PRINTERS PKWY
Practice Address - Street 2:SUITE 150
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-6100
Practice Address - Country:US
Practice Address - Phone:719-577-4104
Practice Address - Fax:719-575-0872
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7103225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist