MEDICARE: MARK PONSTEIN PT, DPT

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	1478	SD

General Provider Information

NPI Number	:	1386997336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK PONSTEIN PT, DPT

Provider Business Mailing Address
First Line	:	8701 W 32ND ST
Second Line	:	ROOM 108 PHYSICAL THERAPY
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-4750
Country	:	US
Telephone Number	:	605-323-6990
Fax Number	:	605-323-6991

Provider Business Practice Location Address
First Line	:	8701 W 32ND ST
Second Line	:	ROOM 108 PHYSICAL THERAPY
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-4750
Country	:	US
Telephone Number	:	605-323-6990
Fax Number	:	605-323-6991

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

Provider Enumeration Date	:	10/16/2012
Last Update Date	:	10/16/2012

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