Individual
NICOLETTE FONSECA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
913 11TH ST SE STE 2, BANDON, OR 97411-9168
(541) 347-4314
(541) 347-8006
Mailing address
2976 IROQUOIS DR, THOMPSONS STATION, TN 37179-5022
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
11-06089
KS
225100000X
Physical Therapist
Primary
11972
TN
Other
Enumeration date
04/12/2021
Last updated
04/12/2021
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