Provider Demographics
NPI:1205096542
Name:REYNON, RONALD CHAN (PT)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:CHAN
Last Name:REYNON
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 1:284 S 10TH ST
Mailing Address - Street 2:APT 8
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-4681
Mailing Address - Country:US
Mailing Address - Phone:541-221-3402
Mailing Address - Fax:
Practice Address - Street 1:2625 KOOS BAY BLVD
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-4907
Practice Address - Country:US
Practice Address - Phone:541-267-2161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5325225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist