| NPI | 1053821959 |
|---|---|
| Former Name | MADISON JUNE VANCE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer |
| Enumeration Date | 2017-10-05 |
| Last Update Date | 2023-06-09 |