Healthcare Provider Details

I. General information

NPI: 1073670063
Provider Name (Legal Business Name): WILLIAM EDWARD RONILO JR. MS, PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BILLY RONILO MS, PT

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 GOODWIN CREST DR
BIRMINGHAM AL
35209-3702
US

IV. Provider business mailing address

5307 HARVEST RIDGE LN
BIRMINGHAM AL
35242-3109
US

V. Phone/Fax

Practice location:
  • Phone: 205-290-4583
  • Fax: 205-290-4560
Mailing address:
  • Phone: 205-980-4524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPTH4348
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: