Individual
MRS. CARRIE PROVENCAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
39 CINEMA BLVD, LEOMINSTER, MA 01453
(978) 466-6677
(978) 466-1133
Mailing address
39 CINEMA BLVD, LEOMINSTER, MA 01453
(978) 466-6677
(978) 466-1133
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10819
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
468151
TUFTS
MA
01
—
Y67949
BCBS
MA
Enumeration date
05/17/2006
Last updated
12/17/2007
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