Healthcare Provider Details

I. General information

NPI: 1871726133
Provider Name (Legal Business Name): VANCE PHYSICAL THERAPY AND WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 W VISALIA RD
EXETER CA
93221
US

IV. Provider business mailing address

511 W VISALIA RD
EXETER CA
93221-1019
US

V. Phone/Fax

Practice location:
  • Phone: 559-592-7117
  • Fax: 559-592-7112
Mailing address:
  • Phone: 559-592-7117
  • Fax: 559-592-7112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT25845
License Number StateCA

VIII. Authorized Official

Name: MR. JOSH VANCE
Title or Position: OWNER
Credential: MPT
Phone: 559-592-7117