Provider Demographics
NPI:1689121923
Name:RONDA, MARCELLA CHRISTENE (PT)
Entity Type:Individual
Prefix:
First Name:MARCELLA
Middle Name:CHRISTENE
Last Name:RONDA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARCELLA
Other - Middle Name:CHRISTENE
Other - Last Name:SICKMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:17900 S PLACITA OCTUBRE
Mailing Address - Street 2:
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-4414
Mailing Address - Country:US
Mailing Address - Phone:520-990-9245
Mailing Address - Fax:520-648-7114
Practice Address - Street 1:17900 S PLACITA OCTUBRE
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-4414
Practice Address - Country:US
Practice Address - Phone:520-990-9245
Practice Address - Fax:520-648-7114
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5502225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist