Provider Demographics
NPI:1992194344
Name:DEMCHAK, RONALD THOMAS
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:THOMAS
Last Name:DEMCHAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 WALES RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16510-5732
Mailing Address - Country:US
Mailing Address - Phone:814-823-3209
Mailing Address - Fax:
Practice Address - Street 1:5601 WALES RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16510-5732
Practice Address - Country:US
Practice Address - Phone:814-823-3209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer