Individual
JANICE LYNETTE FOUNTAIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
4110 N LA FONTANA WAY, BOISE, ID 83702-1559
(208) 867-9869
Mailing address
4110 N LA FONTANA WAY, BOISE, ID 83702-1559
(208) 867-9869
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
882
ID
Other
Enumeration date
08/08/2017
Last updated
07/21/2022
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