MEDICARE: RONALD COXSON JR. PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	010844	OH

General Provider Information

NPI Number	:	1467527879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD COXSON JR. PT

Provider Business Mailing Address
First Line	:	2059 MONROE AVE
Second Line	:	APT 22
City	:	SALEM
State	:	OH
Zip	:	44460-3461
Country	:	US
Telephone Number	:	330-206-4788
Fax Number	:

Provider Business Practice Location Address
First Line	:	2308 SOUTHEAST BLVD
Second Line	:
City	:	SALEM
State	:	OH
Zip	:	44460-3418
Country	:	US
Telephone Number	:	330-332-8488
Fax Number	:	330-332-4441

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	07/08/2007

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