Provider Demographics
NPI:1730173303
Name:VICTORA, KIMBERLY LYNNE (ATC, CSCS, PES)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:LYNNE
Last Name:VICTORA
Suffix:
Gender:F
Credentials:ATC, CSCS, PES
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:LYNNE
Other - Last Name:ZIRBEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC, CSCS, PES
Mailing Address - Street 1:114 GRISWOLD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST SALEM
Mailing Address - State:WI
Mailing Address - Zip Code:54669-9284
Mailing Address - Country:US
Mailing Address - Phone:608-775-8600
Mailing Address - Fax:
Practice Address - Street 1:3111 GUNDERSEN DR
Practice Address - Street 2:NC1-002
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-8447
Practice Address - Country:US
Practice Address - Phone:608-775-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN15622255A2300X
WI221-0392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer