Provider Demographics
NPI:1487267894
Name:PONCE, ALIZA VICTORIA (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:ALIZA
Middle Name:VICTORIA
Last Name:PONCE
Suffix:
Gender:F
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:PO BOX 4465
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78523-4465
Mailing Address - Country:US
Mailing Address - Phone:956-832-7800
Mailing Address - Fax:
Practice Address - Street 1:413 E RAILROAD AVE # A
Practice Address - Street 2:
Practice Address - City:PORT ISABEL
Practice Address - State:TX
Practice Address - Zip Code:78578-4133
Practice Address - Country:US
Practice Address - Phone:956-443-3844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1334777225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist