Doctor Name: | LAILANI PONCE |
NPI Number: | 1225439193 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PT |
License Number: | 070019558 |
Business Practice Address: | 8369 Cherry Ln Laurel, MD - 207074831 |
Business Phone Number: | 2403344333 |
Business Fax Number: | 8554777890 |
Mailing Address: | 415 W Saint Louis Ave Apt G, EFFINGHAM |
State: | IL |
Postal Code: | 624012239 |
Phone Number: | 6184724314 |
Fax Number: | |
NPI Enumeration Date: | 09/10/2014 |
NPI Last Update Date: | 09/10/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 070019558 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |