Provider Demographics
NPI:1205912755
Name:KLINGENSMITH, RONALD E
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:E
Last Name:KLINGENSMITH
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 1:612 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MONONGAHELA
Mailing Address - State:PA
Mailing Address - Zip Code:15063-1814
Mailing Address - Country:US
Mailing Address - Phone:724-258-0123
Mailing Address - Fax:724-258-0125
Practice Address - Street 1:3433 WILLIAM PENN HWY
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-5412
Practice Address - Country:US
Practice Address - Phone:412-824-2807
Practice Address - Fax:412-824-4171
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT008091L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0158191000OtherWEST VIRGINIA MEDICAID
PA555921OtherHIGHMARK BC/BS