Individual
MISS RILEY NEAN FONTAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSAT, ATC, OTC
Contact information
Practice address
230 CLEARFIELD AVE, VIRGINIA BEACH, VA 23462
(757) 321-3300
Mailing address
4005 ROEBLING LN, VIRGINIA BEACH, VA 23452-1868
(802) 309-0450
Taxonomy
Speciality
Code
Description
License number
State
207PS0010X
Sports Medicine (Emergency Medicine) Physician
0126002171
VA
2255A2300X
Athletic Trainer
Primary
0126002171
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16-0804
ORTHOPAEDIC TECHNOLOGIST CERTIFICATION
—
Enumeration date
01/27/2015
Last updated
07/26/2018
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