Provider Demographics
NPI:1255411971
Name:RADAWIEC, RONALD SCOTT (PT, CBIS)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:SCOTT
Last Name:RADAWIEC
Suffix:
Gender:M
Credentials:PT, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1900 S LACHANCE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49651-8022
Mailing Address - Country:US
Mailing Address - Phone:231-775-3081
Mailing Address - Fax:231-775-7740
Practice Address - Street 1:3181 SANDHILL RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854-9425
Practice Address - Country:US
Practice Address - Phone:517-455-0262
Practice Address - Fax:517-336-6050
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2016-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003471225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist