Basic Information
Provider Information
NPI: 1114936150
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SKRNICH
FirstName: DANNY
MiddleName:  
NamePrefix: MR.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 704 SHARON HILLS DR
Address2:  
City: BILOXI
State: MS
PostalCode: 395324360
CountryCode: US
TelephoneNumber: 2285235000
FaxNumber: 2285234501
Practice Location
Address1: 704 SHARON HILLS DR
Address2:  
City: BILOXI
State: MS
PostalCode: 395324360
CountryCode: US
TelephoneNumber: 2285235000
FaxNumber: 2285234501
Other Information
ProviderEnumerationDate: 08/07/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225800000X  Y Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist 

No ID Information.


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