Provider Demographics
NPI:1366506743
Name:VANCE, JOSHUA L (MPT)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:L
Last Name:VANCE
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 W VISALIA RD
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:CA
Mailing Address - Zip Code:93221-1019
Mailing Address - Country:US
Mailing Address - Phone:559-592-7117
Mailing Address - Fax:559-592-7112
Practice Address - Street 1:511 W VISALIA RD
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:CA
Practice Address - Zip Code:93221-1019
Practice Address - Country:US
Practice Address - Phone:559-592-7117
Practice Address - Fax:559-592-7112
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT25845225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist