Provider Demographics
NPI:1619562402
Name:SEIBERLICH, VICTORIA (PTA)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:SEIBERLICH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1552 PATRICIA AVE APT 445
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-0468
Mailing Address - Country:US
Mailing Address - Phone:651-528-9657
Mailing Address - Fax:
Practice Address - Street 1:1100 FLYNN RD STE 207
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-8737
Practice Address - Country:US
Practice Address - Phone:805-388-5678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50995225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant