Provider Demographics
NPI:1659676674
Name:DANIELSON, RONALD L JR (MPT, MS)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:L
Last Name:DANIELSON
Suffix:JR
Gender:M
Credentials:MPT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEADOW BROOK RD
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-3983
Mailing Address - Country:US
Mailing Address - Phone:660-341-9255
Mailing Address - Fax:
Practice Address - Street 1:1 MEADOW BROOK RD
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-3983
Practice Address - Country:US
Practice Address - Phone:660-341-9255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-23
Last Update Date:2011-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO117924225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist