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General NPI Number Information
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NPI Number | 1235271594
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Entity Type | Individual
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Provider Name | TAMIKA FONTAINE P. T.
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Gender | Female
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 05/12/2021
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Provider Practice Location Address
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Address Line | 70 VILLAGE ST
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City | WALDORF
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State | MD
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Zip | 20602-1838
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Country | US
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Telephone | 301-645-2776
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Fax |
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Provider Business Mailing Address
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Address Line | 18602 ACCOKEEK CT
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City | ACCOKEEK
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State | MD
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Zip | 20607-3274
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Country | US
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Telephone | 443-523-6066
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 20126
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License Number State | MD
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