Organization
PRODYNAMICS SPORTS & THERAPEUTIC MASSAGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY PONCAR L.M.T. (MASSAGE THERAPIST)
(303) 332-1903
Entity
Organization
Contact information
Practice address
6180 S GUN CLUB RD UNIT L4, AURORA, CO 80016-5310
(303) 332-1903
Mailing address
1050 S WALDEN WAY APT 104, AURORA, CO 80017-2641
(303) 332-1903
Taxonomy
Speciality
Code
Description
License number
State
261QP3300X
Pain Clinic/Center
Primary
MT.0003476
CO
Other
Enumeration date
01/28/2015
Last updated
01/28/2015
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