Individual
DENISE PROVOOST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1515 EUBANK BLVD SE BLDG 832, ALBUQUERQUE, NM 87185
(505) 844-4237
Mailing address
512 CALIFORNIA STREET, ALBUQUERQUE, NM 87108
(505) 249-9698
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A0714
NM
Other
Enumeration date
10/25/2012
Last updated
10/25/2012
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