Provider Demographics
NPI:1528160843
Name:WENTZ, VICTORIA LYNN (ATC)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LYNN
Last Name:WENTZ
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4435 PHINNEY AVE N APT 303
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-7123
Mailing Address - Country:US
Mailing Address - Phone:206-675-1528
Mailing Address - Fax:
Practice Address - Street 1:18021 15TH AVENUE NE
Practice Address - Street 2:SUITE 210
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-3809
Practice Address - Country:US
Practice Address - Phone:206-362-5255
Practice Address - Fax:206-362-5260
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer