Provider Demographics
NPI:1548586365
Name:PRATT, RONALD R (MA, MAC)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:R
Last Name:PRATT
Suffix:
Gender:M
Credentials:MA, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2051 EDWARDS RD
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:NY
Mailing Address - Zip Code:13165-9574
Mailing Address - Country:US
Mailing Address - Phone:646-319-4657
Mailing Address - Fax:
Practice Address - Street 1:3200 BRIGHTON HENRIETTA TOWN LINE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-2754
Practice Address - Country:US
Practice Address - Phone:585-242-9518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA46960225700000X
NY25 P86184171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist