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General NPI Number Information
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NPI Number | 1689905275
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Entity Type | Individual
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Provider Name | MRS. JEREMY PONCE DE LEON ORCINO
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Gender | Female
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Dates
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Enumeration Date | 01/20/2010
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Last Update Date | 01/20/2010
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Provider Practice Location Address
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Address Line | 10100 HILLVIEW DR
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City | PENSACOLA
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State | FL
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Zip | 32514-5436
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Country | US
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Telephone | 850-478-5119
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Fax |
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Provider Business Mailing Address
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Address Line | 8904 FOREST OAK DR
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City | PENSACOLA
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State | FL
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Zip | 32506-5558
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Country | US
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Telephone |
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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 | PT 25055
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 22798
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License Number State | MD
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