Provider Demographics
NPI:1760756043
Name:PONTIUS, STEPHANIE K (PTA)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:K
Last Name:PONTIUS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:K
Other - Last Name:CLOUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1800 N WABASH RD STE 202
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-1300
Mailing Address - Country:US
Mailing Address - Phone:765-651-3229
Mailing Address - Fax:765-651-3227
Practice Address - Street 1:900 PROVIDENT DR
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-3252
Practice Address - Country:US
Practice Address - Phone:574-371-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-03
Last Update Date:2012-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06003160A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant