Provider Demographics
NPI:1063925220
Name:CUANANG, RONAN ADRIAN MARTIREZ (PT)
Entity type:Individual
Prefix:
First Name:RONAN ADRIAN
Middle Name:MARTIREZ
Last Name:CUANANG
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 1:4127 KINGSHILL CIR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-9718
Mailing Address - Country:US
Mailing Address - Phone:630-290-5161
Mailing Address - Fax:
Practice Address - Street 1:4127 KINGSHILL CIR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-9718
Practice Address - Country:US
Practice Address - Phone:630-290-5161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070022795225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist