| Doctor Name: | DR. MICHAEL LOUIS PROVENZANO |
| NPI Number: | 1225157423 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.C.,D.P.T |
| License Number: | 18057 |
| Business Practice Address: | 16 Haverhill St Andover, MA - 018103002 |
| Business Phone Number: | 9783740700 |
| Business Fax Number: | 9783746052 |
| Mailing Address: | 493 Essex St, LAWRENCE |
| State: | MA |
| Postal Code: | 018401241 |
| Phone Number: | 9786867111 |
| Fax Number: | 9786865502 |
| NPI Enumeration Date: | 03/28/2007 |
| NPI Last Update Date: | 02/16/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 18057 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |