MATTHEW PROVENCE PROVENCE

MONTGOMERY, AL
NPI1720704216
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy225100000X Physical Therapist
(Licence: AL  PTH11015)
Enumeration Date2022-10-17
Last Update Date2022-10-17
Business Address
Mr. MATTHEW PROVENCE PROVENCE DPT,PT
464 SAINT LUKES DR
MONTGOMERY, AL 36117-7104
Phone number: 334-244-6699
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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