Provider Demographics
NPI:1679744064
Name:PONCE DE LEON, ALVIN A (PT)
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:A
Last Name:PONCE DE LEON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 TONEY PENNA DR
Mailing Address - Street 2:SUITE 206A
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-5755
Mailing Address - Country:US
Mailing Address - Phone:561-281-6537
Mailing Address - Fax:
Practice Address - Street 1:175 TONEY PENNA DR
Practice Address - Street 2:SUITE 206A
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-5755
Practice Address - Country:US
Practice Address - Phone:561-746-8148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist