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General NPI Number Information
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NPI Number | 1326754474
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Entity Type | Individual
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Provider Name | RONALD FLORES
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Gender | Male
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Dates
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Enumeration Date | 01/23/2023
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Last Update Date | 01/23/2023
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Provider Practice Location Address
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Address Line | 153 JOHNS CT
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City | SHELTON
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State | WA
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Zip | 98584-8225
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Country | US
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Telephone | 360-427-2575
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Fax |
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Provider Business Mailing Address
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Address Line | 1707 SE MASON ST APT A
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City | SHELTON
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State | WA
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Zip | 98584-1668
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Country | US
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Telephone | 818-317-5064
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | P1.61353482
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License Number State | WA
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