Healthcare Provider Details

I. General information

NPI: 1790347318
Provider Name (Legal Business Name): VICTORIA WOZNISKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2019
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17475 DUGDALE DR
SOUTH BEND IN
46635-1545
US

IV. Provider business mailing address

305 RUNAWAY BAY CIR APT 1C
MISHAWAKA IN
46545-8042
US

V. Phone/Fax

Practice location:
  • Phone: 574-247-7500
  • Fax:
Mailing address:
  • Phone: 570-573-2524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: