Provider Demographics
NPI:1922456383
Name:HOMMEL, VICTORIA (MS, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:HOMMEL
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2126 HOLLYWOOD PL
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46616-2115
Mailing Address - Country:US
Mailing Address - Phone:574-315-8891
Mailing Address - Fax:
Practice Address - Street 1:112 JOYCE CTR
Practice Address - Street 2:
Practice Address - City:NOTRE DAME
Practice Address - State:IN
Practice Address - Zip Code:46556-5678
Practice Address - Country:US
Practice Address - Phone:574-631-3090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36002449A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer