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General NPI Number Information
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NPI Number | 1326654831
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Entity Type | Individual
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Provider Name | MADISON TAYLOR VANCE
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Gender | Female
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Dates
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Enumeration Date | 09/20/2020
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Last Update Date | 09/20/2020
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Provider Practice Location Address
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Address Line | 1830 E DEL RIO DR
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City | TEMPE
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State | AZ
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Zip | 85282-2823
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Country | US
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Telephone | 801-719-9505
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Fax |
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Provider Business Mailing Address
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Address Line | 572 WOODLAND DR
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City | FARMINGTON
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State | UT
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Zip | 84025-3317
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Country | US
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Telephone | 801-719-9505
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | AZ
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