Provider Demographics
NPI:1891965257
Name:RONALD E. PONCHAK, PT, PC
Entity Type:Organization
Organization Name:RONALD E. PONCHAK, PT, PC
Other - Org Name:PONCHAK PHYSICAL THERAPY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR / PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:PONCHAK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:203-722-6266
Mailing Address - Street 1:79 LLEWELLYN DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840
Mailing Address - Country:US
Mailing Address - Phone:203-722-6266
Mailing Address - Fax:203-972-3664
Practice Address - Street 1:1 DANBURY ROAD
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897
Practice Address - Country:US
Practice Address - Phone:203-722-6266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-01
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5065261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy