Joel Provencher, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

040.0069652 Issued in VT

Practice address

1000 Corporate Drive Suite 280
Centra Healthcare Solutions
Fort Lauderdale, FL 33334-3634

Phone

(954) 636-2525

Fax

(800) 436-1011

NPI assigned

Sep 5, 2014

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Centra Healthcare

  • Clinic/Center
  • Fort Lauderdale, FL
  • NPI 1568854180
  NPD (past)

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

{
    "created_epoch": "1409875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1409875200000",
    "number": "1346641602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 CORPORATE DRIVE SUITE 280",
            "address_2": "CENTRA HEALTHCARE SOLUTIONS",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333343634",
            "telephone_number": "954-636-2525",
            "fax_number": "800-436-1011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 CORPORATE DRIVE SUITE 280",
            "address_2": "CENTRA HEALTHCARE SOLUTIONS",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333343634",
            "telephone_number": "954-636-2525",
            "fax_number": "800-436-1011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVENCHER",
        "first_name": "JOEL",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-09-05",
        "last_updated": "2014-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VT",
            "license": "040.0069652",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Prospect Health Solutions Inc
• Prosper Path Health Inc
• Nathalie-Joe Prosper, ARNP
• Vickey Prospere Robillard, FNP
• Proven Theory LLC
• Provide 4 Inc.
• PRS Surgical, LLC
• William J Pruitt III, MD
• Anabel Pruna, DC
• Genesis Nichelle Pruna, BCBA

• Physical Therapist in Fort Lauderdale, FL
• Providers in Fort Lauderdale, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.