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Individual

AMANDA FONTENOT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DPT

Contact information

Practice address
21425G SPRING ST, UNION GROVE, WI 53182-9707
(262) 878-6700
Mailing address
1400G WEST ST APT 3, UNION GROVE, WI 53182-1554

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary

Other

Enumeration date
07/18/2014
Last updated
09/05/2014
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