Individual
MARIO C PONCE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1729 WABASH AVE, ROCHESTER, IN 46975-2455
(574) 475-8518
Mailing address
1313 ROCHESTER BLVD, ROCHESTER, IN 46975
(574) 201-9975
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05004455A
IN
Other
Enumeration date
11/02/2022
Last updated
11/02/2022
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