Provider Demographics
NPI:1467632893
Name:FONTINEL, PAULA RENAE (PT)
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:RENAE
Last Name:FONTINEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2607 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-7924
Mailing Address - Country:US
Mailing Address - Phone:641-621-1401
Mailing Address - Fax:641-628-7308
Practice Address - Street 1:2607 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-7924
Practice Address - Country:US
Practice Address - Phone:641-621-1401
Practice Address - Fax:641-628-7308
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1513225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA208578030Medicaid