Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 3122253 | TX |
N | 2251S0007X | Physical Therapist - Sports | 3122253 | TX |
N | 2251X0800X | Physical Therapist - Orthopedic | 3122253 | TX |
NPI | 1245721125 |
---|---|
Provider Name | Dr. Ronnie Clinton Pawley |
First Address | Dallas, TX 75206-6486 |
Second Address | Ft Worth, TX 76132-6108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2018 |
Last Update Date | 25/05/2018 |