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General NPI Number Information
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NPI Number | 1598095432
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Entity Type | Individual
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Provider Name | MERRELL T PONDER DPT
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Gender | Male
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Dates
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Enumeration Date | 12/27/2009
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Last Update Date | 12/27/2009
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Provider Practice Location Address
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Address Line | 42024 HIGHWAY 195
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City | HALEYVILLE
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State | AL
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Zip | 35565-7054
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Country | US
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Telephone | 205-485-7150
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Fax |
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Provider Business Mailing Address
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Address Line | 210 BUTLER ST
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City | COLUMBIANA
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State | AL
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Zip | 35051-9353
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Country | US
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Telephone | 205-269-7651
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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 | PTH5598
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License Number State | AL
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