Healthcare Provider Details

I. General information

NPI: 1780503615
Provider Name (Legal Business Name): DEBORAH DENISE FORTNER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5923 MONTICELLO DR
MONTGOMERY AL
36117-1940
US

IV. Provider business mailing address

5923 MONTICELLO DR
MONTGOMERY AL
36117-1940
US

V. Phone/Fax

Practice location:
  • Phone: 334-593-6263
  • Fax: 334-593-5599
Mailing address:
  • Phone: 334-593-6263
  • Fax: 334-593-5599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number4238
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: