Provider Demographics
NPI:1639688781
Name:VRANCKEN, JOELLE (PT)
Entity Type:Individual
Prefix:
First Name:JOELLE
Middle Name:
Last Name:VRANCKEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JOELLE
Other - Middle Name:
Other - Last Name:STUTTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:507 S ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-7318
Mailing Address - Country:US
Mailing Address - Phone:386-424-5181
Mailing Address - Fax:386-424-5064
Practice Address - Street 1:507 S ORANGE ST
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-7318
Practice Address - Country:US
Practice Address - Phone:386-424-5181
Practice Address - Fax:386-424-5064
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-20
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT70492081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine