Provider Demographics
NPI:1184789133
Name:PONCE, PATRICIA L (DPT,OSC,SCS,ATC,CSCS)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:L
Last Name:PONCE
Suffix:
Gender:F
Credentials:DPT,OSC,SCS,ATC,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6905 YALE RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-1050
Mailing Address - Country:US
Mailing Address - Phone:410-335-9883
Mailing Address - Fax:410-938-8664
Practice Address - Street 1:2328 W JOPPA RD
Practice Address - Street 2:SUITE 300
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4612
Practice Address - Country:US
Practice Address - Phone:410-938-8660
Practice Address - Fax:410-938-8664
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21138225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist