Provider Demographics
NPI:1548425101
Name:FONDA, BARBARA JO (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:JO
Last Name:FONDA
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:MS
Other - First Name:BARBARA
Other - Middle Name:JO
Other - Last Name:FONDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MASSAGE THERAPIST
Mailing Address - Street 1:PO BOX 701
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-0701
Mailing Address - Country:US
Mailing Address - Phone:315-713-4170
Mailing Address - Fax:
Practice Address - Street 1:609 CANTON ST
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-3811
Practice Address - Country:US
Practice Address - Phone:315-393-1018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019099225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist