Healthcare Provider Details

I. General information

NPI: 1104376664
Provider Name (Legal Business Name): VICTORIA ASHLEY TOROK LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2016
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E 200 N
ST GEORGE UT
84770-2969
US

IV. Provider business mailing address

240 S CHENEY SPANGLE RD APT. 533
CHENEY WA
99004-5137
US

V. Phone/Fax

Practice location:
  • Phone: 435-669-9920
  • Fax:
Mailing address:
  • Phone: 435-669-9920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number98032744810
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: