MEDICARE: MISS DEBORAH ANN PONTI LPTA

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	225200000X	Physical Therapy Assistant	PTA009057	FL

General Provider Information

NPI Number	:	1194928978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DEBORAH ANN PONTI LPTA

Provider Business Mailing Address
First Line	:	8860 DORAL OAKS DR
Second Line	:	#1021
City	:	TEMPLE TERRACE
State	:	FL
Zip	:	33617-6238
Country	:	US
Telephone Number	:	813-914-9176
Fax Number	:

Provider Business Practice Location Address
First Line	:	16405 NORTHCROSS DR
Second Line	:	SUITE G2
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-5091
Country	:	US
Telephone Number	:	704-897-2456
Fax Number	:	480-393-4115

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

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	07/08/2007

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