Individual
GRACE PONTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1604 W 18TH ST, PORTALES, NM 88130-7097
(575) 359-4719
Mailing address
1604 W 18TH ST, PORTALES, NM 88130-7097
(575) 359-4719
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA1371
NM
Other
Enumeration date
12/16/2018
Last updated
12/16/2018
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