Provider Demographics
NPI:1891351490
Name:PONCE, ANTHONY B
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:B
Last Name:PONCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 DAVIS ST STE B
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-7009
Mailing Address - Country:US
Mailing Address - Phone:540-552-5100
Mailing Address - Fax:540-552-5700
Practice Address - Street 1:115 AKERS FARM RD STE 1
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-4865
Practice Address - Country:US
Practice Address - Phone:540-381-9100
Practice Address - Fax:540-381-9102
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305212757225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist