Provider Demographics
NPI:1386997336
Name:PONSTEIN, MARK (PT, DPT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:PONSTEIN
Suffix:
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 1:8701 W 32ND ST
Mailing Address - Street 2:ROOM 108 PHYSICAL THERAPY
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-4750
Mailing Address - Country:US
Mailing Address - Phone:605-323-6990
Mailing Address - Fax:605-323-6991
Practice Address - Street 1:8701 W 32ND ST
Practice Address - Street 2:ROOM 108 PHYSICAL THERAPY
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-4750
Practice Address - Country:US
Practice Address - Phone:605-323-6990
Practice Address - Fax:605-323-6991
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1478225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist