Individual
COURTNEY PROVENCAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
303 N HURSTBOURNE PKWY, SUITE 200, LOUISVILLE, KY 40222-5185
(502) 412-5847
Mailing address
673 E 2ND ST, UNIT #1, BOSTON, MA 02127-1547
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
00838
RI
225200000X
Physical Therapy Assistant
8708
MA
Other
Enumeration date
02/06/2013
Last updated
02/06/2013
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