Provider Demographics
NPI:1093067142
Name:VINTEVOGHEL, VICTORIA MAY (MHSA, AT, ATC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MAY
Last Name:VINTEVOGHEL
Suffix:
Gender:F
Credentials:MHSA, AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3214 DONNA DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-2904
Mailing Address - Country:US
Mailing Address - Phone:586-321-8127
Mailing Address - Fax:
Practice Address - Street 1:6590 MIDDLE LAKE RD
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2423
Practice Address - Country:US
Practice Address - Phone:248-623-5608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010008772255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer