Provider Demographics
NPI:1063286557
Name:CHENOWETH, VICTORIA (PT)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:CHENOWETH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8521 LITT DR SE APT 303
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-4615
Mailing Address - Country:US
Mailing Address - Phone:360-909-5028
Mailing Address - Fax:
Practice Address - Street 1:2102 CARRIAGE ST SW STE B
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-1049
Practice Address - Country:US
Practice Address - Phone:360-866-0408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT61501729225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist