Provider Demographics
NPI:1265003727
Name:DIBBINS, VICTORIA M (PT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:M
Last Name:DIBBINS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 COLONIAL RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2042
Mailing Address - Country:US
Mailing Address - Phone:646-326-4183
Mailing Address - Fax:
Practice Address - Street 1:2 DAVIS POINT LN
Practice Address - Street 2:
Practice Address - City:CAPE ELIZABETH
Practice Address - State:ME
Practice Address - Zip Code:04107-2620
Practice Address - Country:US
Practice Address - Phone:207-767-9773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT4755225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist