Individual
MARY DOUGLAS FORTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
710 LAWERENCE EXPRESSWAY, DEPT.174, SANTA CLARA, CA 95051
(408) 851-1495
(408) 851-1499
Mailing address
5305 ALAN AVE, SAN JOSE, CA 95124-5720
(408) 266-6279
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PT10606
CA
Other
Enumeration date
12/20/2006
Last updated
07/08/2007
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