Provider Demographics
NPI:1295722130
Name:STORM, VIKI W (PT)
Entity type:Individual
Prefix:
First Name:VIKI
Middle Name:W
Last Name:STORM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 RIVER ST.
Mailing Address - Street 2:PO BOX 147
Mailing Address - City:CONWAY
Mailing Address - State:MA
Mailing Address - Zip Code:01341-0147
Mailing Address - Country:US
Mailing Address - Phone:413-369-4348
Mailing Address - Fax:413-369-0282
Practice Address - Street 1:134 RIVER ST.
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:MA
Practice Address - Zip Code:01341-0147
Practice Address - Country:US
Practice Address - Phone:413-369-4348
Practice Address - Fax:413-369-0282
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2193225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP00187267OtherRAILROAD MEDICARE
MA0332844Medicaid
MAY65462OtherBLUE CROSS BLUE SHIELD
MA0332844Medicaid