Provider Demographics
NPI:1982185435
Name:NOTTINGHAM, RONNIE (PTA)
Entity Type:Individual
Prefix:
First Name:RONNIE
Middle Name:
Last Name:NOTTINGHAM
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:75494-3226
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:180 HAMPTON DR
Practice Address - Street 2:
Practice Address - City:FATE
Practice Address - State:TX
Practice Address - Zip Code:75087-6886
Practice Address - Country:US
Practice Address - Phone:903-217-6407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2041226225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant