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NPI Code Detail

MEDICARE: DR. ALIZA VICTORIA PONCE PT, DPT

MEDICARE: DR. ALIZA VICTORIA PONCE 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
1225100000XPhysical Therapist1334777TX

General Provider Information

NPI Number : 1487267894
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ALIZA VICTORIA PONCE PT, DPT
Provider Business Mailing Address
First Line : PO BOX 4465
Second Line :
City : BROWNSVILLE
State : TX
Zip : 78523-4465
Country : US
Telephone Number : 956-832-7800
Fax Number :
Provider Business Practice Location Address
First Line : 413 E RAILROAD AVE # A
Second Line :
City : PORT ISABEL
State : TX
Zip : 78578-4133
Country : US
Telephone Number : 956-443-3844
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2020
Last Update Date : 08/25/2020

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