Provider Demographics
NPI:1023469251
Name:PON, LINDA (ATC)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:
Last Name:PON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10550 ALBION RD
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-2901
Mailing Address - Country:US
Mailing Address - Phone:510-685-0960
Mailing Address - Fax:
Practice Address - Street 1:10550 ALBION RD
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94582-2901
Practice Address - Country:US
Practice Address - Phone:510-685-0960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer