Individual
DR. JONATHAN MICHAEL PROVOST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT, SCS
Contact information
Practice address
241 RUSSELL ST, HADLEY, MA 01035-9558
(413) 586-5552
Mailing address
241 RUSSELL ST, HADLEY, MA 01035-9558
(413) 586-5552
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
21309
MA
Other
Enumeration date
08/26/2014
Last updated
10/31/2022
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