Organization
VICTORY RIDGE ACADEMY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN WHITAKER (EXECUTIVE DIRECTOR)
(863) 679-3338
Entity
Organization
Contact information
Practice address
501 BURNS AVE, LAKE WALES, FL 33853-3335
(863) 679-3338
(863) 679-3944
Mailing address
501 BURNS AVE, LAKE WALES, FL 33853-3335
(863) 679-3338
(863) 679-3944
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
FL
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
FL
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010977000
—
FL
Enumeration date
04/23/2014
Last updated
11/08/2022
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