Healthcare Provider Details

I. General information

NPI: 1063844769
Provider Name (Legal Business Name): RONALD D MASHNI DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1291 N TELEGRAPH RD
MONROE MI
48162-3368
US

IV. Provider business mailing address

1291 N. TELEGRAPH ROAD
MONROE MI
48162-3368
US

V. Phone/Fax

Practice location:
  • Phone: 734-243-0300
  • Fax: 734-243-3066
Mailing address:
  • Phone: 734-243-0300
  • Fax: 734-243-3066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number5501015990
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501015990
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: