Provider Demographics
NPI:1720392335
Name:VIKI W. STORM,P.T. INC.
Entity Type:Organization
Organization Name:VIKI W. STORM,P.T. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIKI
Authorized Official - Middle Name:
Authorized Official - Last Name:STORM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:413-369-4348
Mailing Address - Street 1:134 RIVER ST.
Mailing Address - Street 2:P.O.BOX 147
Mailing Address - City:CONWAY
Mailing Address - State:MA
Mailing Address - Zip Code:01341
Mailing Address - Country:US
Mailing Address - Phone:413-369-4348
Mailing Address - Fax:413-369-0282
Practice Address - Street 1:150 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2232
Practice Address - Country:US
Practice Address - Phone:413-256-8185
Practice Address - Fax:413-369-0282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21932251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00187267OtherRAILROAD MEDICARE
Y65462OtherBLUE CROSS BLUE SHIELD
MA0332844Medicaid
Y68036Medicare PIN