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NPI Code Detail

MEDICARE: MS. COLETTE E, FONTANA LMT

MEDICARE:  MS. COLETTE E, FONTANA  LMT
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
1174400000XSpecialistMA 25322FL

General Provider Information

NPI Number : 1750567210
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. COLETTE E, FONTANA LMT
Provider Business Mailing Address
First Line : 1465 S FORT HARRISON AVE
Second Line : SUITE 206
City : CLEARWATER
State : FL
Zip : 33756-2505
Country : US
Telephone Number : 727-442-2962
Fax Number :
Provider Business Practice Location Address
First Line : 1465 S FORT HARRISON AVE
Second Line : SUITE 206
City : CLEARWATER
State : FL
Zip : 33756-2505
Country : US
Telephone Number : 727-442-2962
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2008
Last Update Date : 01/15/2008

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Directions to “ MS. COLETTE E, FONTANA LMT” Practice Location

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