Individual
MS. TATUM FONTANA
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
721 RESERVOIR AVE, CRANSTON, RI 02910-4430
(401) 946-4250
(401) 275-5645
Mailing address
721 RESERVOIR AVE, CRANSTON, RI 02910-4430
(401) 946-4250
(401) 275-5645
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA00565
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTA00565
RHODE ISLAND PTA LICENSE
RI
Enumeration date
05/28/2006
Last updated
07/08/2007
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