C THOMAS PROVENZANO

PORTLAND, OR
NPI1548241995
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy225100000X Physical Therapist
(Licence: OR  2227)
Enumeration Date2005-11-10
Last Update Date2007-07-08
Business Address
-- C THOMAS PROVENZANO MPT
9260 SE STARK ST SUITE B
PORTLAND, OR 97216-1675
Phone number: 503-255-1500
Mailing Address
-- C THOMAS PROVENZANO MPT
6809 NE HANCOCK ST
PORTLAND, OR 97213-5343
Phone number: 503-280-7346
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