Provider Demographics
NPI:1871588566
Name:SKARADA, TIMOTHY STEPHEN (PT)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:STEPHEN
Last Name:SKARADA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E PLANK RD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-4154
Mailing Address - Country:US
Mailing Address - Phone:814-941-7708
Mailing Address - Fax:814-941-7715
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:PA
Practice Address - Zip Code:16686-1810
Practice Address - Country:US
Practice Address - Phone:814-684-6309
Practice Address - Fax:814-684-6312
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT010099L225100000X
PADAPT000025225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA650021206OtherRR MEDICARE
PA027967OtherHIGHMARK
PA025951PRYMedicare ID - Type Unspecified
PA650021206OtherRR MEDICARE