Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PTH4348 | AL |
NPI | 1073670063 |
---|---|
Provider Name | Mr. William Edward Ronilo JR. |
First Address | Birmingham, AL 35242-3109 |
Second Address | Birmingham, AL 35209-3702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 08/07/2007 |