Basic Information
Provider Information
NPI: 1770078222
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NEWBURY
FirstName: VICTORIA
MiddleName: ELIZABETH
NamePrefix: DR.
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1525 14TH AVE UNIT 505
Address2:  
City: SEATTLE
State: WA
PostalCode: 981224255
CountryCode: US
TelephoneNumber: 2024226641
FaxNumber:  
Practice Location
Address1: 17692 1ST AVE S
Address2:  
City: BURIEN
State: WA
PostalCode: 981481729
CountryCode: US
TelephoneNumber: 2062410477
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/27/2018
LastUpdateDate: 06/27/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X WAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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