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1720704216
MATTHEW PROVENCE PROVENCE
MONTGOMERY, AL
NPI
1720704216
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
225100000X Physical Therapist
(Licence: AL PTH11015)
Enumeration Date
2022-10-17
Last Update Date
2022-10-17
Business Address
Mr. MATTHEW PROVENCE PROVENCE DPT,PT
464 SAINT LUKES DR
MONTGOMERY, AL 36117-7104
Phone number: 334-244-6699
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Mailing Address
Mr. MATTHEW PROVENCE PROVENCE DPT,PT
1803 OKFUSKI TRL
PIKE ROAD, AL 36064-3319
Phone number: 912-401-1262
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