Provider Demographics
NPI:1215000161
Name:FONTENOT, ASHLEY MARIE (PT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MARIE
Last Name:FONTENOT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:MARIE
Other - Last Name:FIFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6756 LANGLEY DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-5178
Mailing Address - Country:US
Mailing Address - Phone:225-663-8232
Mailing Address - Fax:
Practice Address - Street 1:11320 INDUSTRIPLEX BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-4108
Practice Address - Country:US
Practice Address - Phone:225-295-8183
Practice Address - Fax:225-262-1826
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
LA06938225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP00421655OtherRAILROAD MEDICARE
LA4H775C943OtherMEDICARE