Provider Demographics
NPI:1407139405
Name:RONDEAU, ERIC O (DPT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:O
Last Name:RONDEAU
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8559 N LINE CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64154-2100
Mailing Address - Country:US
Mailing Address - Phone:816-468-2011
Mailing Address - Fax:816-468-2007
Practice Address - Street 1:8559 N LINE CREEK PKWY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64154-2100
Practice Address - Country:US
Practice Address - Phone:816-468-2011
Practice Address - Fax:816-468-2007
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04162225100000X
MO2010036113225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist