Provider Demographics
NPI:1275514374
Name:FONTANES, JUNE H (PT)
Entity Type:Individual
Prefix:MRS
First Name:JUNE
Middle Name:H
Last Name:FONTANES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SELDEN DR
Mailing Address - Street 2:
Mailing Address - City:E NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-1342
Mailing Address - Country:US
Mailing Address - Phone:631-261-9150
Mailing Address - Fax:
Practice Address - Street 1:700 BROADWAY
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-2324
Practice Address - Country:US
Practice Address - Phone:516-797-7003
Practice Address - Fax:516-797-7336
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12267225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7272494OtherAETNA
NY99540OtherVYTRA