Provider Demographics
NPI:1134246556
Name:FAIELLA, VICTORIA M (LMT)
Entity type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:M
Last Name:FAIELLA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4980 SW 195TH TERRACE
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEST RANCHES
Mailing Address - State:FL
Mailing Address - Zip Code:33332
Mailing Address - Country:US
Mailing Address - Phone:954-673-1689
Mailing Address - Fax:
Practice Address - Street 1:1920 E HALLANDALE BEACH BLVD
Practice Address - Street 2:STE 901
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4722
Practice Address - Country:US
Practice Address - Phone:954-456-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 25908225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist