Provider Demographics
NPI:1629768866
Name:VERNON, VICTORIA ANN (DPT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ANN
Last Name:VERNON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:ANN
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2904 S BONN AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67217-1923
Mailing Address - Country:US
Mailing Address - Phone:316-640-4027
Mailing Address - Fax:
Practice Address - Street 1:12 S LAKEVIEW CT
Practice Address - Street 2:
Practice Address - City:GODDARD
Practice Address - State:KS
Practice Address - Zip Code:67052-9228
Practice Address - Country:US
Practice Address - Phone:316-252-0445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist