Doctor Name: | MRS. MIMI M FOUNTAIN |
NPI Number: | 1306004965 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NCBTMB, RN |
License Number: | 441885-00 |
Business Practice Address: | 1005 Waterfall Ln Durango, CO - 813013741 |
Business Phone Number: | 9707598872 |
Business Fax Number: | |
Mailing Address: | 1005 Waterfall Ln, DURANGO |
State: | CO |
Postal Code: | 813013741 |
Phone Number: | 9707598872 |
Fax Number: | |
NPI Enumeration Date: | 05/29/2008 |
NPI Last Update Date: | 05/30/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | 441885-00 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |