Provider Demographics
NPI:1205551165
Name:MACKRISS, VICTORIA S (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:S
Last Name:MACKRISS
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 1:728 N FERDON BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-2166
Mailing Address - Country:US
Mailing Address - Phone:850-682-7772
Mailing Address - Fax:888-308-1539
Practice Address - Street 1:728 N FERDON BLVD STE 3
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-2166
Practice Address - Country:US
Practice Address - Phone:850-682-7772
Practice Address - Fax:888-308-1539
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT41632225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1982726683OtherPHYSICAL THERAPY