Provider Demographics
NPI:1316079056
Name:FONTANEZ, LINNETTE (RPT)
Entity type:Individual
Prefix:
First Name:LINNETTE
Middle Name:
Last Name:FONTANEZ
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BO CARMELITA CALLE 15 BZN 104
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:787-604-4248
Mailing Address - Fax:787-855-1565
Practice Address - Street 1:CARMELITA CALLE 15
Practice Address - Street 2:#6
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-604-4248
Practice Address - Fax:787-855-1565
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR999225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR50616OtherPMC
PR870073OtherMMM
PR870073OtherMMM
PR87117Medicare ID - Type Unspecified