Provider Demographics
NPI:1053083956
Name:SOMERS, VICTORIA NICOLE (LMT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:NICOLE
Last Name:SOMERS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:TORI
Other - Middle Name:
Other - Last Name:SOMERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7602 N TADLEY LN APT 308
Mailing Address - Street 2:
Mailing Address - City:SPOTSYLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22551-2940
Mailing Address - Country:US
Mailing Address - Phone:540-907-6373
Mailing Address - Fax:
Practice Address - Street 1:7602 N TADLEY LN APT 308
Practice Address - Street 2:
Practice Address - City:SPOTSYLVANIA
Practice Address - State:VA
Practice Address - Zip Code:22551-2940
Practice Address - Country:US
Practice Address - Phone:540-907-6373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-29
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019010136225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist