Provider Demographics
NPI:1750090049
Name:KRASNOSHEK, VICTORIA A (DPT)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:A
Last Name:KRASNOSHEK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 LANING ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-1603
Mailing Address - Country:US
Mailing Address - Phone:203-441-4261
Mailing Address - Fax:860-736-5013
Practice Address - Street 1:2 BRIDGEWATER RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2269
Practice Address - Country:US
Practice Address - Phone:860-507-7985
Practice Address - Fax:860-507-7993
Is Sole Proprietor?:No
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13778225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist