Provider Demographics
NPI:1033403845
Name:PONESSA MEDICAL MASSAGE
Entity Type:Organization
Organization Name:PONESSA MEDICAL MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:K
Authorized Official - Last Name:PONESSA
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, NCBMT
Authorized Official - Phone:717-519-6700
Mailing Address - Street 1:1864 OREGON PIKE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-6402
Mailing Address - Country:US
Mailing Address - Phone:717-519-6700
Mailing Address - Fax:717-519-6722
Practice Address - Street 1:1864 OREGON PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6402
Practice Address - Country:US
Practice Address - Phone:717-519-6700
Practice Address - Fax:717-519-6722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG000413225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty