Provider Demographics
NPI:1326640970
Name:VICTORY SPORTS THERAPY, PLLC
Entity Type:Organization
Organization Name:VICTORY SPORTS THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SAMPLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:480-796-9720
Mailing Address - Street 1:5635 W BONANZA LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-6364
Mailing Address - Country:US
Mailing Address - Phone:818-645-1735
Mailing Address - Fax:
Practice Address - Street 1:2102 W QUAIL AVE STE 4
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-2656
Practice Address - Country:US
Practice Address - Phone:480-796-9720
Practice Address - Fax:480-631-0565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-09
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy