Provider Demographics
NPI:1629022926
Name:RONDINA, KIM A (DPT)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:A
Last Name:RONDINA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9097 E DESERT COVE DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6279
Mailing Address - Country:US
Mailing Address - Phone:480-860-4298
Mailing Address - Fax:480-860-0356
Practice Address - Street 1:9097 E DESERT COVE AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6710
Practice Address - Country:US
Practice Address - Phone:480-860-4298
Practice Address - Fax:480-860-4298
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5518225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00390141OtherRAILROAD MEDICARE PTAN
AZP00390141OtherRAILROAD MEDICARE PTAN