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General NPI Number Information
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NPI Number | 1568800746
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Entity Type | Individual
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Provider Name | CHRISTIE PONA DPT, ATC
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Gender | Female
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Dates
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Enumeration Date | 06/10/2013
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Last Update Date | 05/31/2018
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Provider Practice Location Address
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Address Line | 4924 CAMPBELL BLVD STE 130A
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City | NOTTINGHAM
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State | MD
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Zip | 21236-5909
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Country | US
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Telephone | 201-978-1464
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Fax |
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Provider Business Mailing Address
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Address Line | 75 W 39TH ST
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City | BAYONNE
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State | NJ
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Zip | 07002-2913
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Country | US
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Telephone | 201-978-1464
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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 |
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License Number State |
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