Individual
MS. KATHY C PROVENCHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
137S MAIN ST, WATERBURY, VT 05676-1579
(802) 244-1140
(802) 244-6851
Mailing address
15 COOPER'S LANDING, WATERBURY, VT 05677-8335
(802) 244-6859
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
0400002724
VT
Other
Enumeration date
01/15/2007
Last updated
09/28/2015
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