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NPI Code Detail

MEDICARE: VICTORIA WENTWORTH DEVINNEY PT

MEDICARE: VICTORIA WENTWORTH DEVINNEY PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist5501003553MI

General Provider Information

NPI Number : 1457570442
Entity Type Code : Individual
Provider Name (Legal Business Name) : VICTORIA WENTWORTH DEVINNEY PT
Provider Business Mailing Address
First Line : 6020 W MAPLE RD
Second Line : STE 500
City : WEST BLOOMFIELD
State : MI
Zip : 48322-4409
Country : US
Telephone Number : 248-851-6999
Fax Number : 248-851-6898
Provider Business Practice Location Address
First Line : 6020 W MAPLE RD
Second Line : STE 500
City : WEST BLOOMFIELD
State : MI
Zip : 48322-4409
Country : US
Telephone Number : 248-851-6999
Fax Number : 248-851-6898
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2007
Last Update Date : 12/18/2012

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Directions to “ VICTORIA WENTWORTH DEVINNEY PT” Practice Location

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