Mary Douglas Fortin

Primary specialty

Pediatric Physical TherapistTaxonomy code 2251P0200X

License

PT10606 Issued in CA

Practice address

710 Lawerence Expressway, Dept.174
Santa Clara, CA 95051

Phone

(408) 851-1495

Fax

(408) 851-1499

NPI assigned

Dec 20, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1215091947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5305 ALAN AVE",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951245720",
            "telephone_number": "408-266-6279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 LAWERENCE EXPRESSWAY, DEPT.174",
            "city": "SANTA CLARA",
            "state": "CA",
            "postal_code": "95051",
            "telephone_number": "408-851-1495",
            "fax_number": "408-851-1499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORTIN",
        "first_name": "MARY",
        "middle_name": "DOUGLAS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "CA",
            "license": "PT10606",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Physical Therapist in Santa Clara, CA
• Providers in Santa Clara, CA by specialty
• Pediatric Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.