MEDICARE: MR. SYLVAIN PONS RPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT18685	CA

General Provider Information

NPI Number	:	1154561801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SYLVAIN PONS RPT

Provider Business Mailing Address
First Line	:	1146 GREENACRE AVE
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5706
Country	:	US
Telephone Number	:	310-248-0148
Fax Number	:

Provider Business Practice Location Address
First Line	:	1146 GREENACRE AVE
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5706
Country	:	US
Telephone Number	:	310-248-0148
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2009
Last Update Date	:	02/20/2009

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