Provider Demographics
NPI:1275724965
Name:VANCE, RALPH EDWARD III (MSPT)
Entity Type:Individual
Prefix:MR
First Name:RALPH
Middle Name:EDWARD
Last Name:VANCE
Suffix:III
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:649 S GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:FRACKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17931-2427
Mailing Address - Country:US
Mailing Address - Phone:570-874-2125
Mailing Address - Fax:570-874-4019
Practice Address - Street 1:649 S GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:FRACKVILLE
Practice Address - State:PA
Practice Address - Zip Code:17931-2427
Practice Address - Country:US
Practice Address - Phone:570-874-2125
Practice Address - Fax:570-874-4019
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018895225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist