Organization
MARY E FONTAINE, MS, RPT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY E FONTAINE MS, RPT (PEDIATRIC PHYSICAL THERAPIST)
(603) 964-8819
Entity
Organization
Contact information
Practice address
654 WALLIS RD, RYE, NH 03870-2245
(603) 964-8819
Mailing address
654 WALLIS RD, RYE, NH 03870-2245
(603) 964-8819
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
PT #0188
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1942422860
NPI
NH
05
—
30003796
—
NH
Enumeration date
04/28/2014
Last updated
04/28/2014
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