Individual
BRIDGET LEA PROVALENKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
805 W ORCHARD DR STE 2, BELLINGHAM, WA 98225-1759
(360) 752-1575
(360) 756-0691
Mailing address
1610 GROVER ST STE B2, LYNDEN, WA 98264-1539
(360) 354-5245
(360) 354-7796
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
08/26/2008
Last updated
08/26/2008
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