Provider Demographics
NPI:1376742494
Name:READNOUR, VICKI ELAINE (PT)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:ELAINE
Last Name:READNOUR
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 1:1935 KENDALL AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-5416
Mailing Address - Country:US
Mailing Address - Phone:816-719-0797
Mailing Address - Fax:
Practice Address - Street 1:167-B SANTA CLAUS LANE
Practice Address - Street 2:
Practice Address - City:NORTH POLE
Practice Address - State:AK
Practice Address - Zip Code:99705
Practice Address - Country:US
Practice Address - Phone:907-488-4978
Practice Address - Fax:907-488-4976
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1948225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist