| Doctor Name: | ANDREW J PROVOST |
| NPI Number: | 1962795583 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSPT |
| License Number: | |
| Business Practice Address: | 1 Braintree St St Allston, MA - 021341956 |
| Business Phone Number: | 6177878700 |
| Business Fax Number: | 6177878106 |
| Mailing Address: | 1 Braintree St St, ALLSTON |
| State: | MA |
| Postal Code: | 021341956 |
| Phone Number: | 6177878700 |
| Fax Number: | 6177878106 |
| NPI Enumeration Date: | 05/17/2011 |
| NPI Last Update Date: | 09/12/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| 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 |