MEDICARE: VICTORIA CHENOWETH PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT61501729	WA

General Provider Information

NPI Number	:	1063286557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA CHENOWETH PT

Provider Business Mailing Address
First Line	:	8521 LITT DR SE APT 303
Second Line	:
City	:	LACEY
State	:	WA
Zip	:	98516-4615
Country	:	US
Telephone Number	:	360-909-5028
Fax Number	:

Provider Business Practice Location Address
First Line	:	2102 CARRIAGE ST SW STE B
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-1049
Country	:	US
Telephone Number	:	360-866-0408
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2023
Last Update Date	:	09/23/2024

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Directions to “ VICTORIA CHENOWETH PT” Practice Location

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