Provider Demographics
NPI:1447801071
Name:VICTORY PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:VICTORY PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INCORPORATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KARTHYAYANI
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNCHAPPA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:517-945-4030
Mailing Address - Street 1:2018 ELWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49283
Mailing Address - Country:US
Mailing Address - Phone:517-945-4030
Mailing Address - Fax:517-750-3269
Practice Address - Street 1:2018 ELWOOD BLVD
Practice Address - Street 2:
Practice Address - City:SPRING ARBOR
Practice Address - State:MI
Practice Address - Zip Code:49283-9682
Practice Address - Country:US
Practice Address - Phone:517-945-4030
Practice Address - Fax:517-750-3269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty