Basic Information
| Provider Information | |||||||||
| NPI: | 1528374279 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHRISTINE FOUTY MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 880 | ||||||||
| Address2: | |||||||||
| City: | DAPHNE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 365260880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516252411 | ||||||||
| FaxNumber: | 2516214837 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 VILLA DR | ||||||||
| Address2: | |||||||||
| City: | DAPHNE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 365264653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514582056 | ||||||||
| FaxNumber: | 2516214837 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2010 | ||||||||
| LastUpdateDate: | 08/19/2010 | ||||||||
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| AuthorizedOfficialLastName: | FOUTY | ||||||||
| AuthorizedOfficialFirstName: | CHRISTINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2514582056 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 26568 | AL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.