Provider Demographics
NPI:1194018523
Name:VANCE, KELLE SNYDER (PT)
Entity Type:Individual
Prefix:
First Name:KELLE
Middle Name:SNYDER
Last Name:VANCE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KELLE
Other - Middle Name:CLARK
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT,
Mailing Address - Street 1:3777 CATCLAW DR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-8203
Mailing Address - Country:US
Mailing Address - Phone:325-695-0545
Mailing Address - Fax:325-695-1006
Practice Address - Street 1:3777 CATCLAW DR
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-8203
Practice Address - Country:US
Practice Address - Phone:325-695-0545
Practice Address - Fax:325-695-1006
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1170301225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist