Provider Demographics
NPI:1285882183
Name:CRIDER, VICTORIA MOORE (PT)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:MOORE
Last Name:CRIDER
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:PO BOX 949
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162
Mailing Address - Country:US
Mailing Address - Phone:706-802-1991
Mailing Address - Fax:
Practice Address - Street 1:1000 HAWTHORNE AVE., STE. S
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606
Practice Address - Country:US
Practice Address - Phone:706-548-1386
Practice Address - Fax:706-369-1903
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007953225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist