Provider Demographics
NPI:1043478753
Name:DEFLUITER, RON EDWARD (PT)
Entity Type:Individual
Prefix:MR
First Name:RON
Middle Name:EDWARD
Last Name:DEFLUITER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:RON
Other - Middle Name:EDWARD
Other - Last Name:DEFLUITER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:302 ST CLOUD ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701
Mailing Address - Country:US
Mailing Address - Phone:605-343-4738
Mailing Address - Fax:605-343-8284
Practice Address - Street 1:302 ST CLOUD ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701
Practice Address - Country:US
Practice Address - Phone:605-343-4738
Practice Address - Fax:605-343-8284
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist