Provider Demographics
NPI:1861690315
Name:SMITH, VICTORIA RENERA-NISA (DPT)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:RENERA-NISA
Last Name:SMITH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:LAMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1102 CELANDINE DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-4164
Mailing Address - Country:US
Mailing Address - Phone:919-208-0518
Mailing Address - Fax:
Practice Address - Street 1:DUKE UNIVERSITY HEALTH SYSTEM
Practice Address - Street 2:4020 NORTH ROXBORO ST
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704
Practice Address - Country:US
Practice Address - Phone:919-613-1720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC111792251P0200X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC068UCOtherBCBS
NC7212247Medicaid