Basic Information
| Provider Information | |||||||||
| NPI: | 1003001249 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAY | ||||||||
| FirstName: | RONNIE | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3815 N VERMILION ST | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618321159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2174467878 | ||||||||
| FaxNumber: | 2174467865 | ||||||||
| Practice Location | |||||||||
| Address1: | 3815 N VERMILION ST | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618321159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2174467878 | ||||||||
| FaxNumber: | 2174467865 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2007 | ||||||||
| LastUpdateDate: | 07/13/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 070 006315 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 070 006315 | 01 | IL | STATE LICENCE NUMBER | OTHER |