Provider Demographics
NPI:1467930206
Name:ANDERSON, VICTORIA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1868 W HEBRON LN STE 101
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-7425
Mailing Address - Country:US
Mailing Address - Phone:502-955-7724
Mailing Address - Fax:
Practice Address - Street 1:1868 W HEBRON LN STE 101
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-7425
Practice Address - Country:US
Practice Address - Phone:502-955-7724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007438225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist