Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 5501015990 | MI |
N | 2251X0800X | Physical Therapist - Orthopedic | 5501015990 | MI |
NPI | 1063844769 |
---|---|
Provider Name | Ronald D Mashni |
First Address | Monroe, MI 48162-3368 |
Second Address | Monroe, MI 48162-3368 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2013 |
Last Update Date | 17/03/2018 |