Provider Demographics
NPI:1649586868
Name:STODDART WALTHER, VICTORIA (VICKI) DAWN (LMT)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA (VICKI)
Middle Name:DAWN
Last Name:STODDART WALTHER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:VICTORIA (VICKI)
Other - Middle Name:DAWN
Other - Last Name:STODDART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:W175N11117 STONEWOOD DR STE 220
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-6508
Mailing Address - Country:US
Mailing Address - Phone:262-224-5679
Mailing Address - Fax:
Practice Address - Street 1:W175N11117 STONEWOOD DR STE 220
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-6508
Practice Address - Country:US
Practice Address - Phone:262-224-5679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI4906-46172M00000X
WI4906-146172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist