Provider Demographics
NPI:1598324931
Name:RE, VICTORIA ELIZABETH (MS, LAT, ATC)
Entity Type:Individual
Prefix:MISS
First Name:VICTORIA
Middle Name:ELIZABETH
Last Name:RE
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 FOLSOM LN
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-7627
Mailing Address - Country:US
Mailing Address - Phone:717-805-5361
Mailing Address - Fax:
Practice Address - Street 1:110 WHITFORD DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27708-2873
Practice Address - Country:US
Practice Address - Phone:717-805-5361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program