Provider Demographics
NPI:1497529259
Name:VICTORIA, AIMET (LMT)
Entity Type:Individual
Prefix:
First Name:AIMET
Middle Name:
Last Name:VICTORIA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1732 NE 26TH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1448
Mailing Address - Country:US
Mailing Address - Phone:954-533-8044
Mailing Address - Fax:
Practice Address - Street 1:1732 NE 26TH ST STE 202
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1448
Practice Address - Country:US
Practice Address - Phone:954-533-8044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA77654225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist