Provider Demographics
NPI:1801893557
Name:PONTI, JEY (PT, MS)
Entity type:Individual
Prefix:
First Name:JEY
Middle Name:
Last Name:PONTI
Suffix:
Gender:M
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:115 COMMONS WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-1906
Mailing Address - Country:US
Mailing Address - Phone:406-756-2555
Mailing Address - Fax:406-756-2558
Practice Address - Street 1:115 COMMONS WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-1906
Practice Address - Country:US
Practice Address - Phone:406-756-2555
Practice Address - Fax:406-756-2558
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MT1857PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO60463OtherBCBS PROVIDER NUMBER
MT3400852Medicaid