Organization
KELLY FOUNTAIN, M.S., L.P.T., L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY FOUNTAIN MS, LPT (OWNER)
(251) 470-7607
Entity
Organization
Contact information
Practice address
2864 DAUPHIN ST, SUITE A, MOBILE, AL 36606-2479
(251) 470-7607
Mailing address
2864 DAUPHIN ST, SUITE A, MOBILE, AL 36606-2479
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
1586
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1003148487
NPI
AL
01
—
511-33704
BLUE CROSS BLUE SHIELD
AL
Enumeration date
03/12/2015
Last updated
03/12/2015
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