TODD PROVOST

BLOOMFIELD, CT
NPI1134311962
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy225200000X Physical Therapy Assistant
(Licence: MA  007915)
Enumeration Date2007-08-15
Last Update Date2007-08-15
Business Address
-- TODD PROVOST PTA
673 COTTAGE GROVE RD
BLOOMFIELD, CT 06002-3033
Phone number: 860-286-1043
Mailing Address
-- TODD PROVOST PTA
40 WOODLAND ST
HARTFORD, CT 06105-2327
Phone number: 860-522-2717
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