Derek Marc Provencher, PT, DPT
NPI 1114609245ActiveIndividual· Physical Therapist· Tampa, FL
Physical Therapist (PT, DPT) in Tampa, Florida, trained at University of South Florida College of Medicine (class of 2023). Enrolled in Medicare as practitioner - physical therapist in private practice.
Overview
| NPI | 1114609245 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | PT, DPT |
| Sole proprietor | No |
| NPI issued | Aug 7, 2023 |
| Last updated in NPPES | Aug 15, 2023 |
| Certified by provider | Aug 15, 2023 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physical Therapist Primary | 225100000X | PTT40333 | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Physical Therapist in Private Practice (FL) |
|---|
Education and affiliations
| Medical school | University of South Florida College of Medicine |
|---|---|
| Graduation year | 2023 |
| Medicare specialty | Physical Therapist In Private Practice |
Medical group
- Visitry Florida LLCTampa, FL · 29 clinicians
Other physical therapists in Tampa
- 1528583051
- 1003092586
- 1003754219
- 1013018985
- 1013684851
- 1013748367
- 1043705783
- 1053387068
- 1053577684
- 1053639286
- 1053881334
- 1063028447
All 831 physical therapists in Tampa · All physical therapists in Florida