Provider Demographics
NPI:1295167898
Name:ST. DON, VICTORIA N (DPT)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:N
Last Name:ST. DON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:N
Other - Last Name:MOFFETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1419 N 14TH AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3475
Mailing Address - Country:US
Mailing Address - Phone:406-586-4678
Mailing Address - Fax:406-586-4670
Practice Address - Street 1:1419 N 14TH AVE UNIT A
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3475
Practice Address - Country:US
Practice Address - Phone:406-586-4678
Practice Address - Fax:406-586-4670
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5948225100000X
MTPTP-PT-LIC-5948225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist