Provider Demographics
NPI:1053431288
Name:VANHORN, VICTORIA LYNN (MS, PT)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LYNN
Last Name:VANHORN
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:LYNN
Other - Last Name:MCCORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, PT
Mailing Address - Street 1:27500 102ND AVE NW
Mailing Address - Street 2:STE 1
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-8092
Mailing Address - Country:US
Mailing Address - Phone:360-629-7528
Mailing Address - Fax:360-629-7632
Practice Address - Street 1:9516 STATE AVE
Practice Address - Street 2:STE B
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-2277
Practice Address - Country:US
Practice Address - Phone:360-658-8857
Practice Address - Fax:360-629-7632
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010392225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
G8865015Medicare PIN