Provider Demographics
NPI:1679142798
Name:CLOSSON, VICTORIA C (PT, DPT, LMT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:C
Last Name:CLOSSON
Suffix:
Gender:F
Credentials:PT, DPT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 CAPE SAINT JOHN RD
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7230
Mailing Address - Country:US
Mailing Address - Phone:303-478-6224
Mailing Address - Fax:
Practice Address - Street 1:256 CAPE SAINT JOHN RD
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7230
Practice Address - Country:US
Practice Address - Phone:303-478-6224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305214320225100000X
MD28952225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist