Provider Demographics
NPI:1265659114
Name:CHADWICK, RONALD L (PT)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:L
Last Name:CHADWICK
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 1:880 BRYANT WAY SW
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-1800
Mailing Address - Country:US
Mailing Address - Phone:907-305-3029
Mailing Address - Fax:
Practice Address - Street 1:8855 SW HOLLY LN STE 123
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-8793
Practice Address - Country:US
Practice Address - Phone:503-582-9246
Practice Address - Fax:503-685-9047
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1194225100000X
OR2342225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist