Provider Demographics
NPI:1396010468
Name:PONTEL, CATIE FERN (PTA)
Entity Type:Individual
Prefix:
First Name:CATIE
Middle Name:FERN
Last Name:PONTEL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W4929 PADDOCK DR
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:WI
Mailing Address - Zip Code:53121-3106
Mailing Address - Country:US
Mailing Address - Phone:414-687-9526
Mailing Address - Fax:
Practice Address - Street 1:270 RIDGE RD
Practice Address - Street 2:
Practice Address - City:WALWORTH
Practice Address - State:WI
Practice Address - Zip Code:53184-9526
Practice Address - Country:US
Practice Address - Phone:262-275-2317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1652-019302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization