Healthcare Provider Details

I. General information

NPI: 1467555441
Provider Name (Legal Business Name): RHONDA RENEE DONLIN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 INLAND EMPIRE BLVD SUITE 100
ONTARIO CA
91764-5513
US

IV. Provider business mailing address

12427 BLAZING STAR CT
RANCHO CUCAMONGA CA
91739-1663
US

V. Phone/Fax

Practice location:
  • Phone: 909-945-5011
  • Fax:
Mailing address:
  • Phone: 909-463-7481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberAT 6228
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: