Provider Demographics
NPI:1245601996
Name:RADDIN, VICTORIA DAWN NEAL (LMT)
Entity Type:Individual
Prefix:
First Name:VICTORIA DAWN
Middle Name:NEAL
Last Name:RADDIN
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 1:8363 BODKIN AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-4738
Mailing Address - Country:US
Mailing Address - Phone:443-852-4070
Mailing Address - Fax:
Practice Address - Street 1:130 LUBRANO DRIVE
Practice Address - Street 2:L7
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:442-444-0929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM05075225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist