Healthcare Provider Details

I. General information

NPI: 1053963942
Provider Name (Legal Business Name): VICTORIA RYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8254 ATLEE RD
MECHANICSVILLE VA
23116-1844
US

IV. Provider business mailing address

1806 LE SUER RD
HENRICO VA
23229-4221
US

V. Phone/Fax

Practice location:
  • Phone: 804-764-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119007627
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: