Provider Demographics
NPI:1003001249
Name:DAY, RONNIE LEE (PT)
Entity Type:Individual
Prefix:MR
First Name:RONNIE
Middle Name:LEE
Last Name:DAY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 N VERMILION ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-1159
Mailing Address - Country:US
Mailing Address - Phone:217-446-7878
Mailing Address - Fax:217-446-7865
Practice Address - Street 1:3815 N VERMILION ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-1159
Practice Address - Country:US
Practice Address - Phone:217-446-7878
Practice Address - Fax:217-446-7865
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070 006315225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070 006315OtherSTATE LICENCE NUMBER
ILL84161Medicare PIN