Kathy C Provencher

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

0400002724 Issued in VT

Practice address

137S Main St
Waterbury, VT 05676-1579

Phone

(802) 244-1140

Fax

(802) 244-6851

NPI assigned

Jan 15, 2007

Last updated

Sep 28, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VT

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

University of Vermont College of Medicine, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Provencher Physical Therapy, Inc.Group PAC ID 8729273925, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Provencher Physical Therapy, Inc.

  dba Family Physcial Therapy

  • Physical Therapy Clinic/Center
  • Waterbury, VT
  • NPI 1225358310

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• Family Physcial Therapy, Inc.

  • Physical Therapist
  • Waterbury, VT
  • NPI 1699868091
  NPD (past)
• Leclair Therapy, Inc.

  • Physical Therapist
  • Essex JCT, VT
  • NPI 1821002189
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1443398400000",
    "number": "1316098619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 COOPER'S LANDING",
            "city": "WATERBURY",
            "state": "VT",
            "postal_code": "056778335",
            "telephone_number": "802-244-6859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "137S MAIN ST",
            "city": "WATERBURY",
            "state": "VT",
            "postal_code": "056761579",
            "telephone_number": "802-244-1140",
            "fax_number": "802-244-6851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVENCHER",
        "first_name": "KATHY",
        "middle_name": "C",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-15",
        "last_updated": "2015-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VT",
            "license": "0400002724",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Seong Hwan Park, DDS
• Victoria L. Pawulak, ADN, RN
• Jonathan B. Phyfe, BA
• Katherine Powell
• Provencher Physical Therapy, Inc. (Family Physcial Therapy)
• Lindsay Quenneville, LIC. AC., MAOM
• Michele Munson Reed, MSW
• Karla N. Riendeau, AS
• Dorothy Rose Robinson
• Moxie Robinson

• Physical Therapist in Waterbury, VT
• Providers in Waterbury, VT by specialty
• Physical Therapist in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.