Provider Demographics
NPI:1407336936
Name:ORTIZ-FENNELL, VICTORIA (PT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:ORTIZ-FENNELL
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 1:143 HAZARD AVE
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4521
Mailing Address - Country:US
Mailing Address - Phone:860-763-2225
Mailing Address - Fax:860-763-3161
Practice Address - Street 1:143 HAZARD AVE
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082
Practice Address - Country:US
Practice Address - Phone:860-763-2225
Practice Address - Fax:860-763-3161
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3934225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist