Provider Demographics
NPI:1093597056
Name:KIEK, RONNIE (PT)
Entity Type:Individual
Prefix:
First Name:RONNIE
Middle Name:
Last Name:KIEK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31720 HIGHWAY 6 APT G
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-8170
Mailing Address - Country:US
Mailing Address - Phone:970-306-5962
Mailing Address - Fax:
Practice Address - Street 1:1140 EDWARDS VLG BLVD STE B-105
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-5525
Practice Address - Country:US
Practice Address - Phone:970-569-3240
Practice Address - Fax:970-569-3260
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0019393225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist