1093049603 NPI number — MISS MARIA KATHRYN PONGONIS PT, DPT

Table of content: MISS MARIA KATHRYN PONGONIS PT, DPT (NPI 1093049603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093049603 NPI number — MISS MARIA KATHRYN PONGONIS PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PONGONIS
Provider First Name:
MARIA
Provider Middle Name:
KATHRYN
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093049603
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
970 LILA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILFORD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45150-1683
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-576-6338
Provider Business Mailing Address Fax Number:
513-576-6340

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2727 MADISON RD
Provider Second Line Business Practice Location Address:
STE 301
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45209-2276
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-871-5571
Provider Business Practice Location Address Fax Number:
513-871-6761
Provider Enumeration Date:
09/29/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  12631 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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