Provider Demographics
NPI:1073031886
Name:FOURNIER, PRESTON (DPT)
Entity Type:Individual
Prefix:
First Name:PRESTON
Middle Name:
Last Name:FOURNIER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:PRESTON
Other - Middle Name:
Other - Last Name:TAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:612 MARR DR
Mailing Address - Street 2:
Mailing Address - City:SIGNAL MOUNTAIN
Mailing Address - State:TN
Mailing Address - Zip Code:37377-2228
Mailing Address - Country:US
Mailing Address - Phone:941-920-7165
Mailing Address - Fax:
Practice Address - Street 1:2050 GADSDEN HWY STE 104
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3260
Practice Address - Country:US
Practice Address - Phone:205-655-7231
Practice Address - Fax:205-655-7232
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH9227225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist