Provider Demographics
NPI:1700296910
Name:MARY E FONTAINE, MS, RPT
Entity Type:Organization
Organization Name:MARY E FONTAINE, MS, RPT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:FONTAINE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RPT
Authorized Official - Phone:603-964-8819
Mailing Address - Street 1:654 WALLIS RD
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:NH
Mailing Address - Zip Code:03870-2245
Mailing Address - Country:US
Mailing Address - Phone:603-964-8819
Mailing Address - Fax:
Practice Address - Street 1:654 WALLIS RD
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:NH
Practice Address - Zip Code:03870-2245
Practice Address - Country:US
Practice Address - Phone:603-964-8819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHPT #0188252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1942422860OtherNPI
NH30003796Medicaid