Provider Demographics
NPI:1306361019
Name:AGUD, VICTORIA (PT, DPT, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:AGUD
Suffix:
Gender:F
Credentials:PT, DPT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 E SPRINGBROOK RD
Mailing Address - Street 2:
Mailing Address - City:BROADWAY
Mailing Address - State:VA
Mailing Address - Zip Code:22815-9526
Mailing Address - Country:US
Mailing Address - Phone:540-901-9501
Mailing Address - Fax:540-901-8873
Practice Address - Street 1:2035 E MARKET ST STE 45
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-8880
Practice Address - Country:US
Practice Address - Phone:540-209-8977
Practice Address - Fax:540-298-8980
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
VA2305214607225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer