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General NPI Number Information
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NPI Number | 1720485667
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Entity Type | Individual
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Provider Name | RON STEVEN KORDONOWY AT
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Gender | Male
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Dates
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Enumeration Date | 11/20/2014
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Last Update Date | 11/20/2014
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Provider Practice Location Address
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Address Line | 3849 W ACAPULCO LN
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City | PHOENIX
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State | AZ
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Zip | 85053-4517
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Country | US
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Telephone | 602-318-7606
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Fax | 623-915-8560
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Provider Business Mailing Address
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Address Line | 3849 W ACAPULCO LN
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City | PHOENIX
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State | AZ
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Zip | 85053-4517
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Country | US
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Telephone | 602-318-7606
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Fax | 623-915-8560
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0263
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License Number State | AZ
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