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1053568691
BRIDGET LEA PROVALENKO
BELLINGHAM, WA
NPI
1053568691
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
2255A2300X Specialist/Technologist Athletic Trainer
Enumeration Date
2008-08-26
Last Update Date
2008-08-26
Business Address
BRIDGET LEA PROVALENKO ATC
805 W ORCHARD DR STE 2
BELLINGHAM, WA 98225-1759
Phone number: 360-752-1575
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Mailing Address
BRIDGET LEA PROVALENKO ATC
1610 GROVER ST STE B2
LYNDEN, WA 98264-1539
Phone number: 360-354-5245
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