Provider Demographics
NPI:1366790933
Name:PATTON, VICTORIA C (ATC)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:C
Last Name:PATTON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:C
Other - Last Name:REILLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:401 US HWY 50 E
Mailing Address - Street 2:PO BOX 216
Mailing Address - City:AVONDALE
Mailing Address - State:CO
Mailing Address - Zip Code:81022
Mailing Address - Country:US
Mailing Address - Phone:719-431-1738
Mailing Address - Fax:
Practice Address - Street 1:401 US HWY 50 E
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:CO
Practice Address - Zip Code:81022
Practice Address - Country:US
Practice Address - Phone:719-431-1738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAT.00010712255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO2000006571OtherATHLETIC TRAINING BOARD OF CERTIFICATION