Healthcare Provider Details

I. General information

NPI: 1992938484
Provider Name (Legal Business Name): RONY KERWIN CHARLES PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2009
Last Update Date: 08/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 CHURCH RD
WYNCOTE PA
19095-1800
US

IV. Provider business mailing address

375 LOCUST RD
GLENSIDE PA
19038-3016
US

V. Phone/Fax

Practice location:
  • Phone: 215-884-9990
  • Fax:
Mailing address:
  • Phone: 215-593-6876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTEI000926
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: