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General NPI Number Information
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NPI Number | 1457890212
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Entity Type | Organization
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Legal Business Name | VICTORY THERAPY
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Dates
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Enumeration Date | 02/13/2017
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Last Update Date | 02/13/2017
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Provider Practice Location Address
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Address Line | 1094 COUNTY ROAD 432
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City | JOAQUIN
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State | TX
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Zip | 75954-1216
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Country | US
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Telephone | 936-572-7334
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Fax |
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Provider Business Mailing Address
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Address Line | 1094 COUNTY ROAD 432
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City | JOAQUIN
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State | TX
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Zip | 75954-1216
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Country | US
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Telephone | 936-572-7334
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Fax |
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Authorized Official
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Title or Position | OWNER/OCCUPATIONAL THERAPIST
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Name | MRS. AMY CLOUSE
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Credential | MOT
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Telephone | 936-572-7334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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