| NPI | 1699964742 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL LOUIS PROVENZANO Owner 978-470-1499 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 18057) |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2024-10-21 |