1194792812 NPI number — VICTORIA PHYSICAL THERAPY PC

Table of content: (NPI 1194792812)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194792812 NPI number — VICTORIA PHYSICAL THERAPY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VICTORIA PHYSICAL THERAPY PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194792812
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 E SAN ANTONIO
Provider Second Line Business Mailing Address:
SUITE 301 W
Provider Business Mailing Address City Name:
VICTORIA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-578-3513
Provider Business Mailing Address Fax Number:
361-578-4623

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 E SAN ANTONIO
Provider Second Line Business Practice Location Address:
SUITE 301 W
Provider Business Practice Location Address City Name:
VICTORIA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-578-3513
Provider Business Practice Location Address Fax Number:
361-578-4623
Provider Enumeration Date:
03/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DROST
Authorized Official First Name:
MARY
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT OF VICTORIA P T PC
Authorized Official Telephone Number:
361-578-3513

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  655760000 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00T47Y . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com