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NPI Code Detail

MEDICARE: ANN MARIE PONDROM PT

MEDICARE: ANN MARIE PONDROM PT
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
1225100000XPhysical Therapist110413MO

General Provider Information

NPI Number : 1366401150
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANN MARIE PONDROM PT
Provider Business Mailing Address
First Line : 14310 HOWARD LN
Second Line :
City : DIXON
State : MO
Zip : 65459-7329
Country : US
Telephone Number : 573-336-3490
Fax Number :
Provider Business Practice Location Address
First Line : 608 OLD ROUTE 66
Second Line :
City : ST ROBERT
State : MO
Zip : 65584-3730
Country : US
Telephone Number : 573-336-8991
Fax Number : 573-336-8993
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2006
Last Update Date : 07/08/2007

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