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General NPI Number Information
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NPI Number | 1700296910
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Entity Type | Organization
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Legal Business Name | MARY E FONTAINE, MS, RPT
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Dates
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Enumeration Date | 04/28/2014
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Last Update Date | 04/28/2014
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Provider Practice Location Address
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Address Line | 654 WALLIS RD
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City | RYE
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State | NH
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Zip | 03870-2245
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Country | US
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Telephone | 603-964-8819
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Fax |
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Provider Business Mailing Address
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Address Line | 654 WALLIS RD
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City | RYE
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State | NH
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Zip | 03870-2245
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Country | US
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Telephone | 603-964-8819
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC PHYSICAL THERAPIST
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Name | MRS. MARY E FONTAINE
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Credential | MS, RPT
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Telephone | 603-964-8819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | PT #0188
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License Number State | NH
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