Provider Demographics
NPI:1235363326
Name:VICTORIO, ROY JAMES (PT)
Entity Type:Individual
Prefix:MR
First Name:ROY JAMES
Middle Name:
Last Name:VICTORIO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:ROY
Other - Middle Name:J
Other - Last Name:VICTORIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:8047 268TH ST
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1543
Mailing Address - Country:US
Mailing Address - Phone:516-395-3992
Mailing Address - Fax:516-232-9554
Practice Address - Street 1:8047 268TH ST
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11004-1543
Practice Address - Country:US
Practice Address - Phone:516-395-3992
Practice Address - Fax:516-232-9554
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18437-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist