Provider Demographics
NPI:1205971330
Name:LIBERI, VICTOR (ATC)
Entity type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:
Last Name:LIBERI
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 LAUREL PINES DR
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-1654
Mailing Address - Country:US
Mailing Address - Phone:207-228-8206
Mailing Address - Fax:
Practice Address - Street 1:33 COLLEGE AVE.
Practice Address - Street 2:UNIVERSITY OF SO. MAINE
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038
Practice Address - Country:US
Practice Address - Phone:207-228-8206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT2112255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer