MEDICARE: DR. LOGAN ASTON PONCE 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	2251S0007X	Sports Physical Therapist	4437	NV
2	2251X0800X	Orthopedic Physical Therapist	294086	CA
3	2251X0800X	Orthopedic Physical Therapist	4437	NV

General Provider Information

NPI Number	:	1740796994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOGAN ASTON PONCE DPT

Provider Business Mailing Address
First Line	:	1720 FOREST WALK DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-4539
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 GRIER DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-3701
Country	:	US
Telephone Number	:	702-352-0200
Fax Number	:

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

Provider Enumeration Date	:	12/26/2017
Last Update Date	:	07/22/2025

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