Individual
AMANDA LYNN PONCE DE LEON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
12171 COVERED WAGON CT, GRANGER, IN 46530-7100
(317) 373-7882
Mailing address
PO BOX 1592, GRANGER, IN 46530-1592
(317) 373-7882
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05013443A
IN
Other
Enumeration date
05/16/2020
Last updated
05/16/2020
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