Provider Demographics
NPI:1952937344
Name:HERTWIG, RONALD WALTER JR
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:WALTER
Last Name:HERTWIG
Suffix:JR
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 1:114 BROADMOOR DR
Mailing Address - Street 2:
Mailing Address - City:FLAT ROCK
Mailing Address - State:NC
Mailing Address - Zip Code:28731-9570
Mailing Address - Country:US
Mailing Address - Phone:770-330-0239
Mailing Address - Fax:
Practice Address - Street 1:114 BROADMOOR DR
Practice Address - Street 2:
Practice Address - City:FLAT ROCK
Practice Address - State:NC
Practice Address - Zip Code:28731-9570
Practice Address - Country:US
Practice Address - Phone:770-330-0239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer