Provider Demographics
NPI:1568472942
Name:FUENTES, ALBERTO ANTONIO II (PT)
Entity type:Individual
Prefix:MR
First Name:ALBERTO
Middle Name:ANTONIO
Last Name:FUENTES
Suffix:II
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 E EMORY RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37938-4617
Mailing Address - Country:US
Mailing Address - Phone:865-947-6622
Mailing Address - Fax:
Practice Address - Street 1:970 E EMORY RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37938-4617
Practice Address - Country:US
Practice Address - Phone:865-947-6622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19123225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ071205Medicaid