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1114609245
DEREK MARC PROVENCHER
TAMPA, FL
NPI
1114609245
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
225100000X Physical Therapist
(Licence: PTT40333)
Enumeration Date
2023-08-07
Last Update Date
2023-08-15
Business Address
DEREK MARC PROVENCHER PT, DPT
16037B TAMPA PALMS BLVD W
TAMPA, FL 33647-2001
Phone number: 813-542-8188
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Mailing Address
DEREK MARC PROVENCHER PT, DPT
9309 PERSIMMON BROOK TRL APT 215
THONOTOSASSA, FL 33592-3963
Phone number:
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