Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251G0304X | Physical Therapist - Geriatrics | 28098 | CA |
Y | 2251G0304X | Physical Therapist - Geriatrics | PT00010638 | WA |
N | 2251X0800X | Physical Therapist - Orthopedic | 28098 | CA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT00010638 | WA |
NPI | 1013005800 |
---|---|
Provider Name | Mr. Lee Robert Skogan |
First Address | Sacramento, CA 95834-7507 |
Second Address | Sacramento, CA 95834-7507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 29/07/2021 |