MEDICARE: PAMELA ANN FONTENOT PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT0460	LA

General Provider Information

NPI Number	:	1275322893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA ANN FONTENOT PT

Provider Business Mailing Address
First Line	:	4462 HATHERN DR
Second Line	:
City	:	PINEVILLE
State	:	LA
Zip	:	71360-4648
Country	:	US
Telephone Number	:	318-730-8690
Fax Number	:

Provider Business Practice Location Address
First Line	:	4462 HATHERN DR
Second Line	:
City	:	PINEVILLE
State	:	LA
Zip	:	71360-4648
Country	:	US
Telephone Number	:	318-730-8690
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2025
Last Update Date	:	05/01/2025

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Directions to “ PAMELA ANN FONTENOT PT” Practice Location

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