Healthcare Provider Details

I. General information

NPI: 1306755392
Provider Name (Legal Business Name): ERIN MICHELLE FONTANA PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN MICHELLE COOK

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 MARKET BLVD
COLLIERVILLE TN
38017-2355
US

IV. Provider business mailing address

511 MARKET BLVD
COLLIERVILLE TN
38017-2355
US

V. Phone/Fax

Practice location:
  • Phone: 901-660-8147
  • Fax:
Mailing address:
  • Phone: 901-660-8147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number4018
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: