Provider Demographics
NPI:1750502696
Name:HUMPHREY, VICKY (PT)
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:VICKY
Other - Middle Name:STARK
Other - Last Name:HUMPHREY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:5676 TARA HILL DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017
Mailing Address - Country:US
Mailing Address - Phone:614-889-2939
Mailing Address - Fax:
Practice Address - Street 1:5672 W BROAD ST
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:OH
Practice Address - Zip Code:43119-8127
Practice Address - Country:US
Practice Address - Phone:614-878-9000
Practice Address - Fax:614-878-8881
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist