Provider Demographics
NPI:1093754020
Name:WILLEKE, RONALD C (MPT)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:C
Last Name:WILLEKE
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4240 BLUE RIDGE BLVD
Mailing Address - Street 2:SUITE 515
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64133-1713
Mailing Address - Country:US
Mailing Address - Phone:816-353-0060
Mailing Address - Fax:816-353-0070
Practice Address - Street 1:4240 BLUE RIDGE BLVD
Practice Address - Street 2:SUITE 515
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64133-1713
Practice Address - Country:US
Practice Address - Phone:816-353-0060
Practice Address - Fax:816-353-0070
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO115000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO34345075OtherBCBS
MOK86D556BMedicare PIN
MO34345075OtherBCBS