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NPI Code Detail

MEDICARE: CELESTINE CECILE FOUNTAIN

MEDICARE: CELESTINE CECILE FOUNTAIN
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
1225100000XPhysical Therapist53649FL

General Provider Information

NPI Number : 1578881454
Entity Type Code : Individual
Provider Name (Legal Business Name) : CELESTINE CECILE FOUNTAIN
Provider Business Mailing Address
First Line : 9750 ATLANTIC DR
Second Line :
City : MIRAMAR
State : FL
Zip : 33025-4275
Country : US
Telephone Number : 954-436-9338
Fax Number :
Provider Business Practice Location Address
First Line : 3107 NE 40TH CT
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33308-6413
Country : US
Telephone Number : 954-454-2345
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2010
Last Update Date : 05/17/2010

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Directions to “ CELESTINE CECILE FOUNTAIN ” Practice Location

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