Provider Demographics
NPI:1962430256
Name:VICORY, RICHARD JUAN (PT, DPT)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:JUAN
Last Name:VICORY
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 FARM GLEN BLVD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1981
Mailing Address - Country:US
Mailing Address - Phone:860-868-4953
Mailing Address - Fax:860-509-4448
Practice Address - Street 1:3 FARM GLEN BLVD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1981
Practice Address - Country:US
Practice Address - Phone:860-868-4953
Practice Address - Fax:860-509-4448
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT16637225100000X
CT12393225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist