Provider Demographics
NPI:1194366906
Name:PONCE, MARTYNA
Entity type:Individual
Prefix:
First Name:MARTYNA
Middle Name:
Last Name:PONCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 S MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1906
Mailing Address - Country:US
Mailing Address - Phone:973-376-4182
Mailing Address - Fax:
Practice Address - Street 1:1076 RIBAUT RD STE 102
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5490
Practice Address - Country:US
Practice Address - Phone:843-379-0836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA296510225100000X
225100000X
SCCP032508T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY051843OtherNEW YORK STATE EDUCATION DEPARTMENT
NJ40QA01994000OtherNEW JERSEY DIVISION OF CONSUMER AFFAIRS
SCCP032508TOtherPT LICENSE
CA296510OtherPHYSICAL THERAPY BOARD OF CALIFORNIA
SC12614OtherBOARD OF PHYSICAL THERAPY
FLPT38839OtherFLORIDA DEPARTMENT OF HEALTH