Individual
DR. ETHAN RAPHAEL LAFONTAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
937 RIVERWALK PKWY STE 101, ROCK HILL, SC 29730-0179
(803) 325-1618
Mailing address
225 BALDWIN AVE, CHARLOTTE, NC 28204-3109
(704) 376-1605
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11552
SC
225100000X
Physical Therapist
P21714
NC
Other
Enumeration date
09/16/2022
Last updated
11/04/2022
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