Provider Demographics
NPI:1366193591
Name:MUTO, VICTORIA LAUREN (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:LAUREN
Last Name:MUTO
Suffix:
Gender:F
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 1:2005 NW 129TH ST
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-7505
Mailing Address - Country:US
Mailing Address - Phone:515-554-8889
Mailing Address - Fax:
Practice Address - Street 1:6201 CENTREVILLE RD STE 100
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2626
Practice Address - Country:US
Practice Address - Phone:703-263-9600
Practice Address - Fax:844-560-1480
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-10
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA111761225100000X
VACP010213T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist