Doctor Name: | MR. JOSHUA J FOUNTAIN |
NPI Number: | 1003122615 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PTA |
License Number: | PTA0672 |
Business Practice Address: | 3718 Pioneer Ave Cheyenne, WY - 820011246 |
Business Phone Number: | 3076319246 |
Business Fax Number: | |
Mailing Address: | 1830 Cheshire Dr, CHEYENNE |
State: | WY |
Postal Code: | 820011684 |
Phone Number: | 3076319246 |
Fax Number: | |
NPI Enumeration Date: | 08/20/2010 |
NPI Last Update Date: | 08/20/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | PTA0672 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WY |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |