Provider Demographics
NPI:1528374279
Name:CHRISTINE FOUTY MD PC
Entity Type:Organization
Organization Name:CHRISTINE FOUTY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOUTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-458-2056
Mailing Address - Street 1:PO BOX 880
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-0880
Mailing Address - Country:US
Mailing Address - Phone:251-625-2411
Mailing Address - Fax:251-621-4837
Practice Address - Street 1:101 VILLA DR
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4653
Practice Address - Country:US
Practice Address - Phone:251-458-2056
Practice Address - Fax:251-621-4837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL26568208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty