Provider Demographics
NPI:1740810100
Name:PONZO, DONALD MARTIN JR (PT, DPT)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:MARTIN
Last Name:PONZO
Suffix:JR
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69461 TAVERNY CT
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-3207
Mailing Address - Country:US
Mailing Address - Phone:504-952-2969
Mailing Address - Fax:
Practice Address - Street 1:653 MYRTLE DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8225
Practice Address - Country:US
Practice Address - Phone:985-893-4700
Practice Address - Fax:985-893-3211
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA093912251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic