Provider Demographics
NPI:1306303169
Name:PONTOON, ALTHEA
Entity type:Individual
Prefix:MRS
First Name:ALTHEA
Middle Name:
Last Name:PONTOON
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 1:144 PRAIRIE DRIVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:FL
Mailing Address - Zip Code:32640
Mailing Address - Country:US
Mailing Address - Phone:352-481-3331
Mailing Address - Fax:352-481-5249
Practice Address - Street 1:144 PRAIRIE DRIVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:FL
Practice Address - Zip Code:32640
Practice Address - Country:US
Practice Address - Phone:352-481-3331
Practice Address - Fax:352-481-5249
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL269536253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care