Marisa Mae Provencher, PT

NPI #1992854061 in Hutchinson, Minnesota

Provider Information

NPI Number: 1992854061
Entity Type: Individual
Name: Marisa Mae Provencher, PT
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physical Therapist
Credential: PT
Enumeration Date: Jan 9, 2007
Last Updated: Jul 8, 2007

Practice Location

Address: 1095 HIGHWAY 15 S
City: Hutchinson
State: Minnesota
ZIP Code: 55350-5000
Phone: (320) 234-5000

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapist	225100000X	Primary

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