Provider Demographics
NPI:1720610819
Name:URBINO, RONEIL (PT, DPT)
Entity Type:Individual
Prefix:
First Name:RONEIL
Middle Name:
Last Name:URBINO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2612 HALLMARK DR
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-2912
Mailing Address - Country:US
Mailing Address - Phone:707-386-1030
Mailing Address - Fax:
Practice Address - Street 1:455 HICKEY BLVD STE 205
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2630
Practice Address - Country:US
Practice Address - Phone:650-746-3299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic