Provider Demographics
NPI:1003585530
Name:VICTORIA, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:VICTORIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:VICTORIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:450 WESTERN HWY STE A
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10962-2188
Mailing Address - Country:US
Mailing Address - Phone:845-596-8713
Mailing Address - Fax:
Practice Address - Street 1:450 WESTERN HWY STE A
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:NY
Practice Address - Zip Code:10962-2188
Practice Address - Country:US
Practice Address - Phone:845-596-8713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039877225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist