Provider Demographics
NPI:1033802566
Name:CLOVER, VICTORIA (LMT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:CLOVER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 MAVERICK RD
Mailing Address - Street 2:
Mailing Address - City:LUSBY
Mailing Address - State:MD
Mailing Address - Zip Code:20657-3404
Mailing Address - Country:US
Mailing Address - Phone:443-771-1066
Mailing Address - Fax:
Practice Address - Street 1:90 HOLIDAY DR
Practice Address - Street 2:SUITE D3
Practice Address - City:SOLOMONS
Practice Address - State:MD
Practice Address - Zip Code:20688
Practice Address - Country:US
Practice Address - Phone:443-771-1066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist