Provider Demographics
NPI:1003653528
Name:FAN, VICTORIA SUSAN WEI (PT, DPT)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:SUSAN WEI
Last Name:FAN
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 1:3280 PEACHTREE RD NE # 110B
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2430
Mailing Address - Country:US
Mailing Address - Phone:770-335-9796
Mailing Address - Fax:
Practice Address - Street 1:3280 PEACHTREE RD NE # 110B
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2430
Practice Address - Country:US
Practice Address - Phone:770-335-9796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT017209225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist