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General NPI Number Information
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NPI Number | 1649252230
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Entity Type | Individual
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Provider Name | DAVID JOSEPH PONTE MA PT OCS
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Gender | Male
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Dates
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Enumeration Date | 11/18/2005
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Last Update Date | 05/04/2009
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Provider Practice Location Address
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Address Line | 2820 HARRIS ST
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City | EUREKA
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State | CA
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Zip | 95503-4809
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Country | US
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Telephone | 707-268-8219
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Fax | 707-268-8264
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Provider Business Mailing Address
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Address Line | 2820 HARRIS ST
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City | EUREKA
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State | CA
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Zip | 95503-4809
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Country | US
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Telephone | 707-268-8219
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Fax | 707-268-8264
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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 | PT57811
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License Number State | CA
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