Provider Demographics
NPI:1003136359
Name:PONSOCK, ALICIA A (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:A
Last Name:PONSOCK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 VETERANS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-4726
Mailing Address - Country:US
Mailing Address - Phone:225-667-6598
Mailing Address - Fax:225-664-8167
Practice Address - Street 1:311 VETERANS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-4726
Practice Address - Country:US
Practice Address - Phone:225-667-6598
Practice Address - Fax:225-664-8167
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07862225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist