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1104271949
ETHAN SKINNER
PHILADELPHIA, PA
NPI
1104271949
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
2255A2300X Specialist/Technologist, Athletic Trainer
Enumeration Date
2016-04-29
Last Update Date
2018-05-10
Business Address
ETHAN SKINNER ATC
4110 SPRUCE ST APT. 2
PHILADELPHIA, PA 19104-4077
Phone number: 703-798-5687
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Mailing Address
ETHAN SKINNER ATC
779 W SPROUL RD
SPRINGFIELD, PA 19064-1215
Phone number: 703-798-5687
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