Provider Demographics
NPI:1811052533
Name:FORTIER, YANETH C
Entity type:Individual
Prefix:
First Name:YANETH
Middle Name:C
Last Name:FORTIER
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 1:2629 BARAMORE OAKS LN
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-8600
Mailing Address - Country:US
Mailing Address - Phone:770-971-6890
Mailing Address - Fax:770-971-8157
Practice Address - Street 1:2629 BARAMORE OAKS LN
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-8600
Practice Address - Country:US
Practice Address - Phone:770-971-6890
Practice Address - Fax:770-971-8157
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007070225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist