Provider Demographics
NPI:1891268207
Name:MCDOWELL, RONALD CHARLES (MS, PT)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:CHARLES
Last Name:MCDOWELL
Suffix:
Gender:M
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 BENICIA DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-3005
Mailing Address - Country:US
Mailing Address - Phone:530-859-5242
Mailing Address - Fax:
Practice Address - Street 1:503 BENICIA DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-3005
Practice Address - Country:US
Practice Address - Phone:530-859-5242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19273225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA19273OtherCALIFORNIA PHYSICAL THERAPY LICENSE