Provider Demographics
NPI:1477155463
Name:FONTENOT, HEATHER E (PT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:E
Last Name:FONTENOT
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:PO BOX 849
Mailing Address - Street 2:
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546-0849
Mailing Address - Country:US
Mailing Address - Phone:337-824-8287
Mailing Address - Fax:337-824-8290
Practice Address - Street 1:3501 HIGHWAY 190
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-5129
Practice Address - Country:US
Practice Address - Phone:337-457-1556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05170225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist