MEDICARE: JEY PONTI PT, MS

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	1857PT	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	60463	OTHER	MO	BCBS PROVIDER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801893557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEY PONTI PT, MS

Provider Business Mailing Address
First Line	:	115 COMMONS WAY
Second Line	:	SUITE 101
City	:	KALISPELL
State	:	MT
Zip	:	59901-1906
Country	:	US
Telephone Number	:	406-756-2555
Fax Number	:	406-756-2558

Provider Business Practice Location Address
First Line	:	115 COMMONS WAY
Second Line	:	SUITE 101
City	:	KALISPELL
State	:	MT
Zip	:	59901-1906
Country	:	US
Telephone Number	:	406-756-2555
Fax Number	:	406-756-2558

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/08/2007

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Directions to “ JEY PONTI PT, MS” Practice Location

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