Provider Demographics
NPI:1205237930
Name:PONCE ZAMOT, RAYMOND (PTA)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:PONCE ZAMOT
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S ORLANDO AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4867
Mailing Address - Country:US
Mailing Address - Phone:407-691-7687
Mailing Address - Fax:407-691-7697
Practice Address - Street 1:801 S ORLANDO AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4867
Practice Address - Country:US
Practice Address - Phone:407-691-7687
Practice Address - Fax:407-691-7697
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24819225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant