Provider Demographics
NPI:1538676465
Name:VIGUE, VICTORIA (PT, DPT, CLT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:VIGUE
Suffix:
Gender:F
Credentials:PT, DPT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3035 WOOSTER RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-4144
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9061 E FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-9317
Practice Address - Country:US
Practice Address - Phone:907-331-6992
Practice Address - Fax:907-802-6559
Is Sole Proprietor?:No
Enumeration Date:2017-12-31
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK131962225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist