Individual
CARLY PON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
6116 MEDAU PL, OAKLAND, CA 94611-2809
(510) 339-2116
(510) 339-0647
Mailing address
6116 MEDAU PLACE, OAKLAND, CA 94602-2809
(510) 339-2116
(510) 339-0647
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PT49084
CA
Other
Enumeration date
05/15/2018
Last updated
05/15/2018
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