Healthcare Provider Details

I. General information

NPI: 1225384191
Provider Name (Legal Business Name): ELIZABETH PONTON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2012
Last Update Date: 03/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1964 ASHLEY RIVER RD SUITE C-1
CHARLESTON SC
29407-4737
US

IV. Provider business mailing address

1964 ASHLEY RIVER RD SUITE C-1
CHARLESTON SC
29407-4737
US

V. Phone/Fax

Practice location:
  • Phone: 843-576-4121
  • Fax: 843-793-3575
Mailing address:
  • Phone: 843-576-4121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6760
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: