Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 11597 | AZ |
NPI | 1003299678 |
---|---|
Provider Name | Ms. Hillary Kristi Vance |
First Address | Glendale, AZ 85308-7177 |
Second Address | Phoenix, AZ 85027-4252 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2015 |
Last Update Date | 01/07/2015 |