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General NPI Number Information
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NPI Number | 1699964742
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Entity Type | Organization
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Legal Business Name | ESSEX PHYSICAL THERAPY
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Dates
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Enumeration Date | 10/15/2007
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 16 HAVERHILL ST
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City | ANDOVER
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State | MA
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Zip | 01810-3002
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Country | US
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Telephone | 978-470-1499
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Fax | 978-470-1408
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Provider Business Mailing Address
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Address Line | 16 HAVERHILL ST
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City | ANDOVER
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State | MA
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Zip | 01810-3002
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Country | US
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Telephone | 978-470-1499
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Fax | 978-470-1408
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL LOUIS PROVENZANO
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Credential | DC DPT
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Telephone | 978-470-1499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 18057
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License Number State | MA
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