Provider Demographics
NPI:1932129020
Name:CHASTAIN, RONNIE LEE JR (ATC)
Entity Type:Individual
Prefix:MR
First Name:RONNIE
Middle Name:LEE
Last Name:CHASTAIN
Suffix:JR
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 VENARD RD
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-1250
Mailing Address - Country:US
Mailing Address - Phone:570-585-9156
Mailing Address - Fax:
Practice Address - Street 1:538 VENARD RD
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-1250
Practice Address - Country:US
Practice Address - Phone:570-585-9326
Practice Address - Fax:570-585-9336
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0035982255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer