| Ponciano Pormentira Jr, DPT | |
|
929 Stacy Burk Drive, Flora, IL 62839 | |
| (618) 662-8060 | |
| (618) 662-8080 |
| Full Name | Ponciano Pormentira Jr |
|---|---|
| Gender | Male |
| Speciality | Physical Therapist |
| Location | 929 Stacy Burk Drive, Flora, Illinois |
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548510357 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225100000X | Physical Therapist | 070.015245 (Illinois) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Ponciano Pormentira Jr, DPT 124 E 4th St, Flora, IL 62839-2009 Ph: () - | Ponciano Pormentira Jr, DPT 929 Stacy Burk Drive, Flora, IL 62839 Ph: (618) 662-8060 |
Jessica Lewis, MPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 929 Stacey Burk Dr, Flora, IL 62839 Phone: 618-662-8060 Fax: 618-662-8080 | |
Cody Burnett, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 929 Stacey Burk Dr, Flora, IL 62839 Phone: 618-662-8060 |