Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA.0014221 | CO |
N | 225200000X | Physical Therapy Assistant | PTA0672 | WY |
NPI | 1003122615 |
---|---|
Provider Name | Mr. Joshua J Fountain |
First Address | Cheyenne, WY 82001-2315 |
Second Address | Wellington, CO 80549 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2010 |
Last Update Date | 19/12/2018 |