Healthcare Provider Details

I. General information

NPI: 1619252145
Provider Name (Legal Business Name): RONALD W HENDERSHOT RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2011
Last Update Date: 10/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1683 ASHWOOD LN
BIRMINGHAM AL
35209-1200
US

IV. Provider business mailing address

1683 ASHWOOD LN
BIRMINGHAM AL
35209-1200
US

V. Phone/Fax

Practice location:
  • Phone: 205-718-2448
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number2492
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: