Provider Demographics
NPI:1649516105
Name:ESKEW, RONNIE SHANE (PT)
Entity type:Individual
Prefix:
First Name:RONNIE
Middle Name:SHANE
Last Name:ESKEW
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 1:13635 E 104TH AVE
Mailing Address - Street 2:STE 700
Mailing Address - City:COMMERCE CITY
Mailing Address - State:CO
Mailing Address - Zip Code:80022-9584
Mailing Address - Country:US
Mailing Address - Phone:720-506-5340
Mailing Address - Fax:720-506-5343
Practice Address - Street 1:13635 E 104TH AVE
Practice Address - Street 2:STE 700
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022-9584
Practice Address - Country:US
Practice Address - Phone:720-506-5340
Practice Address - Fax:720-506-5343
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10125225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist