Victoria Dereszkiewicz, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

ATR-009214 Issued in AZ

Practice address

8405 N Pima Center Pkwy Ste 101
Scottsdale, AZ 85258-4669

Phone

(602) 648-5444

Fax

(602) 772-3801

NPI assigned

Oct 2, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1696204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696982400000",
    "number": "1932989571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 80217",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850600217",
            "telephone_number": "602-385-2115",
            "fax_number": "480-418-3323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8405 N PIMA CENTER PKWY STE 101",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852584669",
            "telephone_number": "602-648-5444",
            "fax_number": "602-772-3801"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9219 E Hidden Spur Trl Ste 100",
            "address_purpose": "LOCATION",
            "city": "Scottsdale",
            "state": "AZ",
            "postal_code": "852556708",
            "country_code": "US",
            "telephone_number": "602-648-5444",
            "fax_number": "602-772-3801",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DERESZKIEWICZ",
        "first_name": "VICTORIA",
        "name_prefix": "Miss",
        "credential": "LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-10-02",
        "last_updated": "2023-10-11",
        "certification_date": "2023-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "AZ",
            "license": "ATR-009214",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Scottsdale, AZ
• Providers in Scottsdale, AZ by specialty
• Athletic Trainer in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.