Provider Demographics
NPI:1184150831
Name:RONDA, NORMAN REY PADUA (PT)
Entity type:Individual
Prefix:MR
First Name:NORMAN REY
Middle Name:PADUA
Last Name:RONDA
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 1:2775 N ROADRUNNER PKWY
Mailing Address - Street 2:APT 2603
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8112
Mailing Address - Country:US
Mailing Address - Phone:310-923-6141
Mailing Address - Fax:
Practice Address - Street 1:2775 N ROADRUNNER PKWY
Practice Address - Street 2:APT 2603
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8112
Practice Address - Country:US
Practice Address - Phone:310-923-6141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4820225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist