Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mia Provenzano

Individual provider Athletic Trainer · NPI 1093199499

Mia Provenzano is an Athletic Trainer in Mesa, Arizona. Practices as a sole proprietor. Registered with an NPI since 2015.

In the registry since
2015

Practice location Address checks out

1320 S Val Vista Dr Apt 1066
Mesa, AZ 85204-6491
Phone: (989) 964-1089
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Athletic Trainer (primary) Taxonomy 2255A2300X

Record details

NPI number1093199499
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedJuly 15, 2015
Last updated in NPPESJuly 15, 2015
Mailing address1320 S Val Vista Dr Apt 1066, Mesa, AZ 85204-6491

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