Provider Demographics
NPI:1265477178
Name:FOUNTAIN, JOSEPH L (ATC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:L
Last Name:FOUNTAIN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 RED GLEN RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4975
Mailing Address - Country:US
Mailing Address - Phone:860-344-1268
Mailing Address - Fax:
Practice Address - Street 1:161 CROSS ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06459-0001
Practice Address - Country:US
Practice Address - Phone:860-685-3528
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer