Provider Demographics
NPI:1275830671
Name:HENRIQUES, ALLISON FONTAINE (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:FONTAINE
Last Name:HENRIQUES
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MAITLAND ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-4508
Mailing Address - Country:US
Mailing Address - Phone:774-202-1839
Mailing Address - Fax:
Practice Address - Street 1:9 POPE ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-5425
Practice Address - Country:US
Practice Address - Phone:508-997-3358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2129225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant