Individual
MRS. SUZIE JEFFERIS SKINNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
2200 CROW LN STE 201, MYRTLE BEACH, SC 29577-1663
(843) 727-1000
Mailing address
PO BOX 421718, GEORGETOWN, SC 29442-4203
(843) 652-8226
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305202321
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010333814
—
VA
01
—
193615
ANTHEM
VA
01
—
193617
ANTHEM
VA
01
—
7801800
AETNA
VA
01
—
P00337585
MEDICARE RAILROAD
—
Enumeration date
04/10/2006
Last updated
03/11/2021
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