Doctor Name: | DANIELLE FOUNTAIN |
NPI Number: | 1578855326 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMT, NCTMB, MMP |
License Number: | MA48413 |
Business Practice Address: | 212 San Marco Ave Ste C St Augustine, FL - 320842771 |
Business Phone Number: | 9043471855 |
Business Fax Number: | |
Mailing Address: | 10 Dupont Ln, ST AUGUSTINE |
State: | FL |
Postal Code: | 320843208 |
Phone Number: | 9043471855 |
Fax Number: | |
NPI Enumeration Date: | 05/12/2011 |
NPI Last Update Date: | 10/12/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | MA48413 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
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. |