Individual
IAN PROVENCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
9055 SPRINGBROOK DR NW, COON RAPIDS, MN 55433-5841
(763) 228-2781
Mailing address
7226 58TH AVE N, MINNEAPOLIS, MN 55428-3222
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
—
—
Other
Enumeration date
01/14/2025
Last updated
01/14/2025
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