Provider Demographics
NPI:1881095982
Name:JALANDONI THALER, RONALEN LABISCASE (PTA, PT)
Entity type:Individual
Prefix:
First Name:RONALEN
Middle Name:LABISCASE
Last Name:JALANDONI THALER
Suffix:
Gender:F
Credentials:PTA, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 LAVETA TER
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-4304
Mailing Address - Country:US
Mailing Address - Phone:310-880-5103
Mailing Address - Fax:
Practice Address - Street 1:658 LAVETA TER
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-4304
Practice Address - Country:US
Practice Address - Phone:310-880-5103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT10503225200000X
NY009268225200000X
NY62038873225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF2505916OtherCA ID