Provider Demographics
NPI:1770689549
Name:PURSNER, RONALD HENRY (PT)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:HENRY
Last Name:PURSNER
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 1:55 CARLTON ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30602-1503
Mailing Address - Country:US
Mailing Address - Phone:706-542-8634
Mailing Address - Fax:706-542-0214
Practice Address - Street 1:55 CARLTON ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30602-1503
Practice Address - Country:US
Practice Address - Phone:706-542-8634
Practice Address - Fax:706-542-0214
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008066225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT008066OtherGA BOARD OF PHYSICAL THER
GA343176596AMedicaid
GAPT008066OtherGA BOARD OF PHYSICAL THER