DEREK MARC PROVENCHER

TAMPA, FL
NPI1114609245
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy225100000X Physical Therapist
(Licence:   PTT40333)
Enumeration Date2023-08-07
Last Update Date2023-08-15
Business Address
DEREK MARC PROVENCHER PT, DPT
16037B TAMPA PALMS BLVD W
TAMPA, FL 33647-2001
Phone number: 813-542-8188
Mailing Address
DEREK MARC PROVENCHER PT, DPT
9309 PERSIMMON BROOK TRL APT 215
THONOTOSASSA, FL 33592-3963
Phone number:
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