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Mia Provenzano
NPI 1093199499 · on the registry since 2015 · sole proprietor
Practice
- Address
- 1320 S Val Vista Dr Apt 1066
Mesa, AZ 85204 - Phone
- (989) 964-1089
- Clinicians at this address
- 2
Registry record
- Primary taxonomy
- Athletic Trainer
2255A2300X
- Sex
- Female
- Record last updated
- 2015-07-15
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Arizona