JOHANNA CAROLINE PROVENCHER

GULF BREEZE, FL
NPI1508481938
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy225100000X Physical Therapist
(Licence: FL  PT40856)
Additional Taxonomies225100000X Physical Therapist
(Licence: NC  P19565)
Enumeration Date2020-06-11
Last Update Date2024-01-11
Business Address
JOHANNA CAROLINE PROVENCHER DPT
1040 GULF BREEZE PKWY STE 200
GULF BREEZE, FL 32561-7808
Phone number: 850-916-3700
Mailing Address
JOHANNA CAROLINE PROVENCHER DPT
11945 SAN JOSE BLVD STE 300
JACKSONVILLE, FL 32223-1627
Phone number: 904-396-1725