Individual
ETHAN SKINNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
4110 SPRUCE ST, APT. 2, PHILADELPHIA, PA 19104-4077
(703) 798-5687
Mailing address
779 W SPROUL RD, SPRINGFIELD, PA 19064-1215
(703) 798-5687
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
PA
Other
Enumeration date
04/29/2016
Last updated
05/10/2018
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