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Individual

MS. MARY ELIZABETH PONZO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PT

Contact information

Practice address
1155 N MAYFAIR RD, SPINE CARE CLINIC AT PLANK ROAD, MILWAUKEE, WI 53226-3421
(414) 955-7182
Mailing address
1155 N MAYFAIR RD, SPINE CARE CLINIC AT PLANK ROAD, MILWAUKEE, WI 53226-3421
(414) 955-7182

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2096
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
008000215J
HUMANA
05
1346294345
WI
Enumeration date
05/22/2006
Last updated
08/22/2014
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