Healthcare Provider Details

I. General information

NPI: 1134634082
Provider Name (Legal Business Name): VICTORIA KILROY MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 12/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 HAVERHILL RD STE 344
AMESBURY MA
01913-2139
US

IV. Provider business mailing address

110 HAVERHILL RD STE 344
AMESBURY MA
01913-2139
US

V. Phone/Fax

Practice location:
  • Phone: 978-491-8084
  • Fax: 978-491-8084
Mailing address:
  • Phone: 978-378-3358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number10767-AH-PT
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: