Basic Information
| Provider Information | |||||||||
| NPI: | 1205913670 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SKELTON | ||||||||
| FirstName: | SABRINA | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2404 S LOCUST ST | ||||||||
| Address2: | STE 5 | ||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880015789 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5755214188 | ||||||||
| FaxNumber: | 5755213668 | ||||||||
| Practice Location | |||||||||
| Address1: | 2404 S LOCUST ST | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880015789 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5055214188 | ||||||||
| FaxNumber: | 5055213668 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 05/11/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2857 | NM | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 70031380 | 05 | NM | MEDICAID | NM00Q436 | 01 | NM | BCBS NM | OTHER |