Provider Demographics
NPI:1053997841
Name:SIERRA, VICTORIA ELISA (PT)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ELISA
Last Name:SIERRA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3731 E PUEBLO AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-1854
Mailing Address - Country:US
Mailing Address - Phone:520-400-3362
Mailing Address - Fax:
Practice Address - Street 1:1818 E SKY HARBOR CIR N UNIT 2
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-3407
Practice Address - Country:US
Practice Address - Phone:602-244-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-31678225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist