Provider Demographics
NPI:1992394951
Name:PEIXOTO, VICTORIA MARGARET (PTA)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MARGARET
Last Name:PEIXOTO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:M
Other - Last Name:BALUIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22 DEWEY AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02911-1803
Mailing Address - Country:US
Mailing Address - Phone:401-617-6238
Mailing Address - Fax:
Practice Address - Street 1:178 NORWOOD AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02905-3923
Practice Address - Country:US
Practice Address - Phone:401-302-1264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPTA012212251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIPTA01221OtherPHYSICAL THERAPY LICENSE