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NPI Code Detail

MEDICARE: MR. RONALD JAY KRONEMEYER PHYSICAL THERAPIST

MEDICARE: MR. RONALD JAY KRONEMEYER PHYSICAL THERAPIST
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist5501001107MI

General Provider Information

NPI Number : 1477612620
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RONALD JAY KRONEMEYER PHYSICAL THERAPIST
Provider Business Mailing Address
First Line : 1870 MAIN ST
Second Line :
City : HOLLAND
State : MI
Zip : 49424-6213
Country : US
Telephone Number : 616-212-5120
Fax Number :
Provider Business Practice Location Address
First Line : 3400 WILSON AVE SW
Second Line :
City : GRANDVILLE
State : MI
Zip : 49418-1854
Country : US
Telephone Number : 616-212-5120
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2006
Last Update Date : 11/05/2018

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