Provider Demographics
NPI:1144554072
Name:VOLLEN, RONALD (PT)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:VOLLEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 POWDERHORN DR
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4201
Mailing Address - Country:US
Mailing Address - Phone:203-438-7775
Mailing Address - Fax:
Practice Address - Street 1:74 POWDERHORN DR
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4201
Practice Address - Country:US
Practice Address - Phone:203-438-7775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005940225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist