MEDICARE: CHRISTINA VICTOR

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	208100000X	Physical Medicine & Rehabilitation Physician	37234	FL
2	208100000X	Physical Medicine & Rehabilitation Physician	1349579	TX
3	208100000X	Physical Medicine & Rehabilitation Physician	2305214807	VA

General Provider Information

NPI Number	:	1437810074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA VICTOR

Provider Business Mailing Address
First Line	:	6396 GOODRICH RD
Second Line	:
City	:	CLARENCE CENTER
State	:	NY
Zip	:	14032-9664
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1420 SPRING HILL RD
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22102-3006
Country	:	US
Telephone Number	:	571-765-1730
Fax Number	:

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

Provider Enumeration Date	:	01/05/2022
Last Update Date	:	01/05/2022

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Directions to “ CHRISTINA VICTOR ” Practice Location

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