Provider Demographics
NPI:1962092171
Name:REAGAN, VICTORIA (ATC)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:REAGAN
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 1:35 KOSCIUSZKO ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-1608
Mailing Address - Country:US
Mailing Address - Phone:603-627-9728
Mailing Address - Fax:603-627-0880
Practice Address - Street 1:35 KOSCIUSZKO ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1608
Practice Address - Country:US
Practice Address - Phone:603-627-9728
Practice Address - Fax:603-627-0880
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer