Individual
DR. MICHAEL F LA FOUNTAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
EDD, ATC, FACSM
Contact information
Practice address
400 S ORANGE AVE, SOUTH ORANGE, NJ 07079-2697
(973) 275-2918
Mailing address
400 S ORANGE AVE, SOUTH ORANGE, NJ 07079-2697
(973) 275-2918
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
25MT00116500
NJ
Other
Enumeration date
07/13/2020
Last updated
07/13/2020
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