MEDICARE: VIKI W. STORM,P.T. INC.

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
1	2251G0304X	Geriatric Physical Therapist	2193	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00187267	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	Y65462	OTHER		BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720392335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIKI W. STORM,P.T. INC.

Provider Business Mailing Address
First Line	:	134 RIVER ST.
Second Line	:	P.O.BOX 147
City	:	CONWAY
State	:	MA
Zip	:	01341
Country	:	US
Telephone Number	:	413-369-4348
Fax Number	:	413-369-0282

Provider Business Practice Location Address
First Line	:	150 UNIVERSITY DR
Second Line	:
City	:	AMHERST
State	:	MA
Zip	:	01002-2232
Country	:	US
Telephone Number	:	413-256-8185
Fax Number	:	413-369-0282

Authorized Official
Title or Position	:	PRESIDENT
Name	:	VIKI STORM
Credential	:	PT
Telephone Number	:	413-369-4348

Provider Enumeration Date	:	08/06/2010
Last Update Date	:	08/06/2010

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