Healthcare Provider Details

I. General information

NPI: 1366710642
Provider Name (Legal Business Name): THOMAS PAUL LAFONTAINE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E SOUTHAMPTON RD
COLUMBIA MO
65203-9533
US

IV. Provider business mailing address

6307 S OLD VILLAGE RD
COLUMBIA MO
65203-9533
US

V. Phone/Fax

Practice location:
  • Phone: 573-777-7474
  • Fax: 573-777-7484
Mailing address:
  • Phone: 573-673-6700
  • Fax: 573-442-2581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: