Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA1659 | AL |
NPI | 1003296971 |
---|---|
Provider Name | Labreeska Ponder |
First Address | Gadsden, AL 35903 |
Second Address | Gadsden, AL 35903-1195 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2015 |
Last Update Date | 04/06/2015 |