Provider Demographics
NPI:1336160936
Name:KEAGLE, RONNA ROSS (DPT)
Entity Type:Individual
Prefix:
First Name:RONNA
Middle Name:ROSS
Last Name:KEAGLE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:RONNA
Other - Middle Name:LYNN
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9409 BETHANY PL
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-1227
Mailing Address - Country:US
Mailing Address - Phone:301-325-1890
Mailing Address - Fax:
Practice Address - Street 1:9409 BETHANY PL
Practice Address - Street 2:
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-1227
Practice Address - Country:US
Practice Address - Phone:301-325-1890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20276225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist