Mr Edward Lee Ponce, PT is a
Physical Medicine & Rehabilitation based in Bloomington, Illinois. Mr Edward Lee Ponce is licensed to practice in Illinois (license number 070-010014) and his current practice location is
1111 Trinity Ln Ste 111, Bloomington, Illinois. He can be reached at his office (for appointments etc.) via phone at
(309) 663-6461.
NPI number for Mr Edward Lee Ponce is 1528176138 and his current mailing address is 1111 Trinity Ln Ste 111, Bloomington, Illinois. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1528176138.
Healthcare Provider's Profile
| Full Name | Mr Edward Lee Ponce |
|---|
| Gender | Male |
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| Speciality | Physical Medicine & Rehabilitation |
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| Location | 1111 Trinity Ln Ste 111, Bloomington, Illinois |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1528176138
- Provider Enumeration Date: 08/25/2006
- Last Update Date: 01/04/2018
Medical Identifiers
Medical identifiers for Mr Edward Lee Ponce such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1528176138 | NPI | - | NPPES |
| 619710010 | Other | IL | MEDICARE PTAN |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 2251X0800X | Physical Therapist - Orthopedic | 070010014 (Illinois) | Secondary |
| 208100000X | Physical Medicine & Rehabilitation | 070-010014 (Illinois) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Edward Lee Ponce is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Mr Edward Lee Ponce, PT
1111 Trinity Ln Ste 111,
Bloomington, IL 61704-8112
Ph: (309) 663-6461 | Mr Edward Lee Ponce, PT
1111 Trinity Ln Ste 111,
Bloomington, IL 61704-8112
Ph: (309) 663-6461 |
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