Individual
JOSEPH L FOUNTAIN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
161 CROSS ST, MIDDLETOWN, CT 06459-0001
(860) 685-3528
Mailing address
74 RED GLEN RD, MIDDLETOWN, CT 06457-4975
(860) 344-1268
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
06/17/2006
Last updated
07/08/2007
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