Organization
PROVENCHER PHYSICAL THERAPY, INC.
Active
Other names
Family Physcial Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATHLEEN C. PROVENCHER (OWNER)
(802) 324-5138
Entity
Organization
Contact information
Practice address
137 S MAIN ST, WATERBURY, VT 05676-1579
(802) 244-1140
Mailing address
137 S MAIN ST, WATERBURY, VT 05676-1579
(802) 244-1140
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
040-0002724
VT
Other
Enumeration date
06/11/2010
Last updated
06/11/2010
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