Provider Demographics
NPI:1881732089
Name:PONTES, KRISTIN ADDONA (DPT)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:ADDONA
Last Name:PONTES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 BURROUGHS DR
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-3504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9 PINE CONE DR
Practice Address - Street 2:SUITE 104 B
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8686
Practice Address - Country:US
Practice Address - Phone:386-446-9716
Practice Address - Fax:386-446-0046
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20182225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88765700Medicaid