Provider Demographics
NPI:1871063800
Name:TUTTLE, VICTORIA F
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:F
Last Name:TUTTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:282 EXETER RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:CT
Mailing Address - Zip Code:06249-1321
Mailing Address - Country:US
Mailing Address - Phone:860-336-1067
Mailing Address - Fax:
Practice Address - Street 1:282 EXETER RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:CT
Practice Address - Zip Code:06249-1321
Practice Address - Country:US
Practice Address - Phone:860-336-1067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1848225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant