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General NPI Number Information
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NPI Number | 1760278063
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Entity Type | Individual
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Provider Name | CRISTIAN PONCE
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Gender |
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Dates
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Enumeration Date | 04/15/2025
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 10790 TOEPPERWEIN RD
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City | CONVERSE
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State | TX
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Zip | 78109-2569
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Country | US
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Telephone | 253-226-4707
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Fax |
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Provider Business Mailing Address
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Address Line | 1208 SPAULDING ST
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City | SAN ANGELO
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State | TX
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Zip | 76903-5031
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Country | US
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Telephone | 325-249-5027
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2187614
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License Number State | TX
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