Provider Demographics
NPI:1922401413
Name:FONTAINE, JOSEPH D (DPT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:D
Last Name:FONTAINE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5627 BANKERS AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-2615
Mailing Address - Country:US
Mailing Address - Phone:225-927-3000
Mailing Address - Fax:
Practice Address - Street 1:5627 BANKERS AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-2615
Practice Address - Country:US
Practice Address - Phone:225-927-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-29
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08967R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA08967ROtherSTATE LICENSE