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General NPI Number Information
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NPI Number | 1427675545
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Entity Type | Individual
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Provider Name | DR. VICTORIA ASHLEY GRACE DWYER
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Gender | Female
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Dates
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Enumeration Date | 07/06/2020
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Last Update Date | 07/06/2020
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Provider Practice Location Address
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Address Line | 523 HAYES LN
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City | PETALUMA
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State | CA
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Zip | 94952-4011
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Country | US
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Telephone | 707-763-2457
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Fax |
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Provider Business Mailing Address
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Address Line | 561 FANO LN
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City | SONOMA
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State | CA
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Zip | 95476-5502
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Country | US
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Telephone | 707-260-4151
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number | 298440
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License Number State | CA
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