Provider Demographics
NPI:1720594765
Name:CLEMENTS, VICTORIA LOVE (PT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LOVE
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:SHARPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:350 NEW FIDELITY CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2665
Mailing Address - Country:US
Mailing Address - Phone:919-258-2714
Mailing Address - Fax:910-423-5552
Practice Address - Street 1:3801 WAKE FOREST RD STE 230
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6864
Practice Address - Country:US
Practice Address - Phone:919-322-0042
Practice Address - Fax:910-423-5552
Is Sole Proprietor?:No
Enumeration Date:2017-12-27
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP17643225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist