Provider Demographics
NPI:1265986046
Name:PONCE, ANGEL RAMON (DPT)
Entity type:Individual
Prefix:MR
First Name:ANGEL
Middle Name:RAMON
Last Name:PONCE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 N GRIMES ST
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-1816
Mailing Address - Country:US
Mailing Address - Phone:575-392-4129
Mailing Address - Fax:575-392-3835
Practice Address - Street 1:2700 N GRIMES ST
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-1816
Practice Address - Country:US
Practice Address - Phone:575-392-4129
Practice Address - Fax:575-392-3835
Is Sole Proprietor?:No
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3613225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist