Provider Demographics
NPI:1891578357
Name:FORTUNA, VICTORIA MICHELLE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MICHELLE
Last Name:FORTUNA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 SCHOOL HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-3798
Mailing Address - Country:US
Mailing Address - Phone:609-617-1127
Mailing Address - Fax:
Practice Address - Street 1:501 5TH ST STE 1
Practice Address - Street 2:
Practice Address - City:ATCO
Practice Address - State:NJ
Practice Address - Zip Code:08004-1861
Practice Address - Country:US
Practice Address - Phone:856-768-3811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02201100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist