# PROVENCHER PHYSICAL THERAPY, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Family Physcial Therapy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225358310
- **Authorized official:** MRS. KATHLEEN C. PROVENCHER (OWNER)
- **Authorized official phone:** (802) 324-5138

## Contact information

- **Practice address:** 137 S MAIN ST, WATERBURY, VT 05676-1579
- **Practice address phone:** (802) 244-1140
- **Mailing address:** 137 S MAIN ST, WATERBURY, VT 05676-1579
- **Mailing address phone:** (802) 244-1140

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2000X | Physical Therapy Clinic/Center | 040-0002724 | VT | Yes |

## Other

- **Enumeration date:** 06/11/2010
- **Last updated:** 06/11/2010