Provider Demographics
NPI:1174976336
Name:SKRABANEK, WINDEE (MED LAT)
Entity type:Individual
Prefix:
First Name:WINDEE
Middle Name:
Last Name:SKRABANEK
Suffix:
Gender:F
Credentials:MED LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 LITTLE ELM LOOP
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76501-7424
Mailing Address - Country:US
Mailing Address - Phone:254-721-7933
Mailing Address - Fax:
Practice Address - Street 1:415 N 31ST ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-2426
Practice Address - Country:US
Practice Address - Phone:254-215-7093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT26412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer