Mario C Ponce Jr, PT | |
1729 Wabash Ave, Rochester, IN 46975-2455 | |
(574) 475-8518 | |
Not Available |
Full Name | Mario C Ponce Jr |
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Gender | Male |
Speciality | Physical Therapist |
Location | 1729 Wabash Ave, Rochester, Indiana |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1760199491 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
225100000X | Physical Therapist | 05004455A (Indiana) | Primary |
Provider Name | Aegis Group Practice Llc |
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Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1083227169 PECOS PAC ID: 5193036432 Enrollment ID: O20201023002377 |
Mailing Address | Practice Location Address |
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Mario C Ponce Jr, PT 1313 Rochester Blvd, Rochester, IN 46975 Ph: (574) 201-9975 | Mario C Ponce Jr, PT 1729 Wabash Ave, Rochester, IN 46975-2455 Ph: (574) 475-8518 |
Derrek Freshour, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 827 W 13th St, Rochester, IN 46975 Phone: 574-223-4331 | |
Bradley Marshaall Rogers, PT, MPA, MPM, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1400 E 9th St, Rochester, IN 46975 Phone: 574-224-1166 | |
Aegis Group Practice Llc Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1729 Wabash Ave, Rochester, IN 46975 Phone: 800-444-6845 |