Provider Demographics
NPI:1316223282
Name:FONTAINE, MELINDA (DPT)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:FONTAINE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 VAN NESS AVE STE 603
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-3016
Mailing Address - Country:US
Mailing Address - Phone:415-440-7600
Mailing Address - Fax:415-440-6803
Practice Address - Street 1:2000 VAN NESS AVE STE 603
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-3016
Practice Address - Country:US
Practice Address - Phone:415-440-7600
Practice Address - Fax:415-440-6803
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37867225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist