Glen Fontenelle, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

Practice address

2104 N Austin Ave
Georgetown, TX 78626-4511

Phone

(512) 761-7307

Fax

(737) 787-2773

NPI assigned

Feb 19, 2021

Sex

Male

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fontenelle Physiotherapy, PLLC Dba Caliber Rehab and Performance

  • Physical Therapist
  • Georgetown, TX
  • NPI 1972449403
  NPD Authorized official

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

{
    "created_epoch": "1613692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726099200000",
    "number": "1245823244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2104 N AUSTIN AVE",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786264511",
            "telephone_number": "512-761-7307",
            "fax_number": "737-787-2773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2104 N AUSTIN AVE",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786264511",
            "telephone_number": "512-761-7307",
            "fax_number": "737-787-2773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONTENELLE",
        "first_name": "GLEN",
        "name_prefix": "Dr.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-02-19",
        "last_updated": "2024-09-12",
        "certification_date": "2024-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven Flores, LCSW
• Karla Gabriella Flotte, DC
• FM Care LLC
• Sara Fogg
• Fontenelle Physiotherapy, PLLC Dba Caliber Rehab and Performance
• Kay Fooshee, R.PH.
• Foot & Ankle Specialists of Arizona PLLC
• Crystal L Force, LPC
• Kerry K Ford, MD
• Terri Foskey

• Physical Therapist in Georgetown, TX
• Providers in Georgetown, TX by specialty
• Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2024; 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.