Provider Demographics
NPI:1265471825
Name:FONTENOT, SCOTT THOMAS (MPT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:THOMAS
Last Name:FONTENOT
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15938 TALL HTS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255-3304
Mailing Address - Country:US
Mailing Address - Phone:210-372-9535
Mailing Address - Fax:
Practice Address - Street 1:3453 IH 35 N
Practice Address - Street 2:SUITE 207B
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78219-2333
Practice Address - Country:US
Practice Address - Phone:210-587-4606
Practice Address - Fax:210-298-2658
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1125987225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist