Provider Demographics
NPI:1932696689
Name:PONTIUS, TERRY R
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:R
Last Name:PONTIUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9259 LIBERTY SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-9589
Mailing Address - Country:US
Mailing Address - Phone:740-439-0203
Mailing Address - Fax:
Practice Address - Street 1:2510 GLENN HWY
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-9028
Practice Address - Country:US
Practice Address - Phone:740-439-0203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator