Provider Demographics
NPI:1851407654
Name:NANCE, JOSEPHINE LYNNE (PT)
Entity Type:Individual
Prefix:MS
First Name:JOSEPHINE
Middle Name:LYNNE
Last Name:NANCE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:JODY
Other - Middle Name:LYNNE
Other - Last Name:NANCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:209 SANDALWOOD CT
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240
Mailing Address - Country:US
Mailing Address - Phone:209-334-1501
Mailing Address - Fax:
Practice Address - Street 1:3663 ARCH RD
Practice Address - Street 2:ST 400
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95215-8315
Practice Address - Country:US
Practice Address - Phone:209-943-0202
Practice Address - Fax:209-943-2209
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT16882225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist