Provider Demographics
NPI:1790177897
Name:RALSTON, VICTORIA (LMT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:RALSTON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 SARAH AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH ABINGTON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18411-9048
Mailing Address - Country:US
Mailing Address - Phone:570-586-1632
Mailing Address - Fax:570-587-3281
Practice Address - Street 1:910 SARAH AVE
Practice Address - Street 2:
Practice Address - City:SOUTH ABINGTON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18411-9048
Practice Address - Country:US
Practice Address - Phone:570-586-1632
Practice Address - Fax:570-587-3281
Is Sole Proprietor?:No
Enumeration Date:2015-02-26
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG006235225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist