Individual
DONNA PROVOST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
422 S 9TH ST, PERKASIE, PA 18944-1330
(215) 817-4534
Mailing address
422 S 9TH ST, PERKASIE, PA 18944-1330
(215) 817-4534
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MSG007679
PA
Other
Enumeration date
11/30/2018
Last updated
11/30/2018
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