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General NPI Number Information
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NPI Number | 1487267894
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Entity Type | Individual
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Provider Name | ALIZA VICTORIA PONCE PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 08/25/2020
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Last Update Date | 08/25/2020
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Provider Practice Location Address
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Address Line | 413 E RAILROAD AVE # A
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City | PORT ISABEL
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State | TX
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Zip | 78578-4133
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Country | US
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Telephone | 956-443-3844
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4465
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City | BROWNSVILLE
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State | TX
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Zip | 78523-4465
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Country | US
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Telephone | 956-832-7800
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1334777
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License Number State | TX
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