Provider Demographics
NPI:1669220794
Name:SKINNER, JARED KILE (ROLFER LMT)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:KILE
Last Name:SKINNER
Suffix:
Gender:M
Credentials:ROLFER LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 CHESTNUT ST STE E
Mailing Address - Street 2:
Mailing Address - City:EMMAUS
Mailing Address - State:PA
Mailing Address - Zip Code:18049-1919
Mailing Address - Country:US
Mailing Address - Phone:541-921-7771
Mailing Address - Fax:
Practice Address - Street 1:1245 CHESTNUT ST STE E
Practice Address - Street 2:
Practice Address - City:EMMAUS
Practice Address - State:PA
Practice Address - Zip Code:18049-1919
Practice Address - Country:US
Practice Address - Phone:541-921-7771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG0135772255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer