Provider Demographics
NPI:1598813651
Name:PONTIUS, HEATHER (PT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:PONTIUS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:694 GREEN FOREST PL
Mailing Address - Street 2:
Mailing Address - City:LITHOPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:43136-7502
Mailing Address - Country:US
Mailing Address - Phone:614-565-7715
Mailing Address - Fax:844-274-2879
Practice Address - Street 1:694 GREEN FOREST PL
Practice Address - Street 2:
Practice Address - City:LITHOPOLIS
Practice Address - State:OH
Practice Address - Zip Code:43136-7502
Practice Address - Country:US
Practice Address - Phone:614-565-7715
Practice Address - Fax:844-274-2879
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7623225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist