Individual
MR. CODY RANDALL PONTIUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MED, ATC, LAT
Contact information
Practice address
460 DAVIS PARK RD, PONTE VEDRA, FL 32081-0544
(904) 547-7387
(904) 547-7355
Mailing address
460 DAVIS PARK RD, PONTE VEDRA, FL 32081-0544
(904) 547-7387
(904) 547-7355
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AL3584
FL
Other
Enumeration date
04/18/2017
Last updated
04/18/2017
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