Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 5502005999 | MI |
NPI | 1013559939 |
---|---|
Provider Name | Robin Fountain |
First Address | Kennett Square, PA 19348-3109 |
Second Address | Kennett Square, PA 19348-3109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2019 |
Last Update Date | 14/01/2022 |