Provider Demographics
NPI:1013973445
Name:KELLAN, VICTORIA P (PT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:P
Last Name:KELLAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:35 MOUNT PLEASANT RD
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-3844
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1591 YANCEYVILLE ST STE 400
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-6945
Practice Address - Country:US
Practice Address - Phone:336-274-7480
Practice Address - Fax:336-274-8903
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01195500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist