Provider Demographics
NPI:1104221480
Name:EDWARDS, VICTOR TRACY (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:TRACY
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 RICHMOND ST
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24263-6505
Mailing Address - Country:US
Mailing Address - Phone:276-346-4161
Mailing Address - Fax:
Practice Address - Street 1:395 RICHMOND ST
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:VA
Practice Address - Zip Code:24263-6505
Practice Address - Country:US
Practice Address - Phone:276-346-4161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility