Search › Pennsylvania › 332B00000X
John Provost, C.PED
NPI 1992821920 · on the registry since 2007 · sole proprietor
Practice
- Address
- 25 Laurel Mall
Provost Shoes
Hazleton, PA 18202 - Phone
- (570) 455-7704
- Fax
- (570) 455-7704
- Organisation at this address
- Provost Shoes
Inferred from a shared address, not stated in the registry.
Registry record
- Primary taxonomy
- 332B00000X
332B00000X
- Licence states on file
- PA
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2007-07-08
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 Pennsylvania