Provider Demographics
NPI:1407572985
Name:PAIVA, RONALD
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:PAIVA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17927 OVERLOOK LOOP APT 8106
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-1941
Mailing Address - Country:US
Mailing Address - Phone:774-331-6091
Mailing Address - Fax:
Practice Address - Street 1:17927 OVERLOOK LOOP APT 8106
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259-1941
Practice Address - Country:US
Practice Address - Phone:774-331-6091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2161991225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant