Provider Demographics
NPI:1093049603
Name:PONGONIS, MARIA KATHRYN (PT, DPT)
Entity Type:Individual
Prefix:MISS
First Name:MARIA
Middle Name:KATHRYN
Last Name:PONGONIS
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 1:970 LILA AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-1683
Mailing Address - Country:US
Mailing Address - Phone:513-576-6338
Mailing Address - Fax:513-576-6340
Practice Address - Street 1:2727 MADISON RD
Practice Address - Street 2:STE 301
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209-2276
Practice Address - Country:US
Practice Address - Phone:513-871-5571
Practice Address - Fax:513-871-6761
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH12631225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist