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General NPI Number Information
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NPI Number | 1003122615
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Entity Type | Individual
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Provider Name | JOSHUA J FOUNTAIN PTA
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Gender | Male
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Dates
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Enumeration Date | 08/20/2010
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Last Update Date | 12/19/2018
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Provider Practice Location Address
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Address Line | 6598 BUTTERCUP DR UNIT 1
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City | WELLINGTON
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State | CO
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Zip | 80549
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Country | US
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Telephone | 970-699-2260
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Fax | 970-514-3519
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Provider Business Mailing Address
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Address Line | 4502 GREENFIELD CT
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City | CHEYENNE
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State | WY
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Zip | 82001-2315
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Country | US
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Telephone | 307-757-5310
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA0672
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA.0014221
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License Number State | CO
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