Basic Information
Provider Information
NPI: 1003001249
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DAY
FirstName: RONNIE
MiddleName: LEE
NamePrefix: MR.
NameSuffix:  
Credential: P.T.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
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
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X070 006315ILY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

ID Information
IDTypeStateIssuerDescription
070 00631501ILSTATE LICENCE NUMBEROTHER


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