Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 07862 | LA |
NPI | 1003136359 |
---|---|
Provider Name | Ms. Alicia A Ponsock |
First Address | Denham Springs, LA 70726-4726 |
Second Address | Denham Springs, LA 70726-4726 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2010 |
Last Update Date | 09/06/2010 |