Provider Demographics
NPI:1700262011
Name:PONGRAC, CHELSEY
Entity Type:Individual
Prefix:
First Name:CHELSEY
Middle Name:
Last Name:PONGRAC
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 1:4599 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:STOYSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15563-8730
Mailing Address - Country:US
Mailing Address - Phone:814-279-6213
Mailing Address - Fax:
Practice Address - Street 1:4599 RIDGE RD
Practice Address - Street 2:
Practice Address - City:STOYSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15563-8730
Practice Address - Country:US
Practice Address - Phone:814-279-6213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE010422225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant