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General NPI Number Information
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NPI Number | 1225630270
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Entity Type | Individual
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Provider Name | RONIE MINA PT, CLT
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Gender | Male
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Dates
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Enumeration Date | 11/13/2020
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Last Update Date | 11/14/2020
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Provider Practice Location Address
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Address Line | 1240 N OGDEN DR #1
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90046
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Country | US
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Telephone | 626-200-8896
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Fax |
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Provider Business Mailing Address
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Address Line | 1240 N OGDEN DR #1
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90046
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Country | US
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Telephone | 626-200-8896
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 293018
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License Number State | CA
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