Individual
MR. MATTHEW PROVENCE PROVENCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT,PT
Contact information
Practice address
464 SAINT LUKES DR, MONTGOMERY, AL 36117-7104
(334) 244-6699
Mailing address
1803 OKFUSKI TRL, PIKE ROAD, AL 36064-3319
(912) 401-1262
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PTH11015
AL
Other
Enumeration date
10/17/2022
Last updated
10/17/2022
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