Provider Demographics
NPI:1558842658
Name:THAKUR, RONAKSINGH (PT)
Entity Type:Individual
Prefix:
First Name:RONAKSINGH
Middle Name:
Last Name:THAKUR
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 1:1700 CROWN RD
Mailing Address - Street 2:
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948-6526
Mailing Address - Country:US
Mailing Address - Phone:618-967-8741
Mailing Address - Fax:
Practice Address - Street 1:210 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:ENERGY
Practice Address - State:IL
Practice Address - Zip Code:62933-3568
Practice Address - Country:US
Practice Address - Phone:618-942-7014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070022068225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist