Individual
DANIELLE K PROVOST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
60 E SILVER ST, WESTFIELD, MA 01085-4434
(413) 562-5121
Mailing address
65 COOPER ST, WEST SPRINGFIELD, MA 01089-2807
(413) 204-8648
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
16149
MA
Other
Enumeration date
12/07/2012
Last updated
12/07/2012
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