Provider Demographics
NPI:1538104278
Name:D'AUTEUIL, VICTORIA ANNE (PT)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:ANNE
Last Name:D'AUTEUIL
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:PO BOX 330541
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96733-0541
Mailing Address - Country:US
Mailing Address - Phone:808-283-2595
Mailing Address - Fax:
Practice Address - Street 1:737 LOWER MAIN ST
Practice Address - Street 2:SUITE B2
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1400
Practice Address - Country:US
Practice Address - Phone:808-249-8680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1565225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH54203Medicare PIN