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NPI Code Detail

MEDICARE: MR. DAVID JOSEPH PONTE MA PT OCS

MEDICARE: MR. DAVID JOSEPH PONTE MA PT OCS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT57811CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11649252230OTHERCANPI

General Provider Information

NPI Number : 1649252230
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DAVID JOSEPH PONTE MA PT OCS
Provider Business Mailing Address
First Line : 2820 HARRIS ST
Second Line :
City : EUREKA
State : CA
Zip : 95503-4809
Country : US
Telephone Number : 707-268-8219
Fax Number : 707-268-8264
Provider Business Practice Location Address
First Line : 2820 HARRIS ST
Second Line :
City : EUREKA
State : CA
Zip : 95503-4809
Country : US
Telephone Number : 707-268-8219
Fax Number : 707-268-8264
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2005
Last Update Date : 05/04/2009

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