Individual
TODD PROVOST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
673 COTTAGE GROVE RD, BLOOMFIELD, CT 06002-3033
(860) 286-1043
(860) 286-2836
Mailing address
40 WOODLAND ST, HARTFORD, CT 06105-2327
(860) 522-2717
(860) 249-6164
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
007915
MA
Other
Enumeration date
08/15/2007
Last updated
08/15/2007
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