Provider Demographics
NPI:1730106741
Name:FONTENOT, MARIAN S
Entity Type:Individual
Prefix:MS
First Name:MARIAN
Middle Name:S
Last Name:FONTENOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4940 VIDRINE RD
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-8780
Mailing Address - Country:US
Mailing Address - Phone:337-506-3510
Mailing Address - Fax:337-506-3511
Practice Address - Street 1:4940 VIDRINE RD
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-8780
Practice Address - Country:US
Practice Address - Phone:337-506-3510
Practice Address - Fax:337-506-3511
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPT00451225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA56124Medicare PIN