Healthcare Provider Details

I. General information

NPI: 1407139405
Provider Name (Legal Business Name): ERIC O RONDEAU DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2011
Last Update Date: 04/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8559 N LINE CREEK PKWY
KANSAS CITY MO
64154-2100
US

IV. Provider business mailing address

8559 N LINE CREEK PKWY
KANSAS CITY MO
64154-2100
US

V. Phone/Fax

Practice location:
  • Phone: 816-468-2011
  • Fax: 816-468-2007
Mailing address:
  • Phone: 816-468-2011
  • Fax: 816-468-2007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-04162
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2010036113
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: