Provider Demographics
NPI:1568404630
Name:FONTENOT, JAMES T (PT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:T
Last Name:FONTENOT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:T
Other - Last Name:FONTENOT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 822
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-0822
Mailing Address - Country:US
Mailing Address - Phone:337-363-0095
Mailing Address - Fax:337-363-5497
Practice Address - Street 1:433 JACK MILLER RD
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-5635
Practice Address - Country:US
Practice Address - Phone:337-363-0095
Practice Address - Fax:337-363-5497
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPT0440225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist