Provider Demographics
NPI:1164666764
Name:CHAPMAN, RONDA GAIL (PT)
Entity type:Individual
Prefix:
First Name:RONDA
Middle Name:GAIL
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 WAVERLY AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2374
Mailing Address - Country:US
Mailing Address - Phone:616-847-8736
Mailing Address - Fax:
Practice Address - Street 1:1380 E SHERMAN BLVD STE B
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1814
Practice Address - Country:US
Practice Address - Phone:231-672-2630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501001197225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist