Provider Demographics
NPI:1215427190
Name:STRADER, RONALD STEVEN (PT)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:STEVEN
Last Name:STRADER
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 1:3106 CATCAY DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-2910
Mailing Address - Country:US
Mailing Address - Phone:361-446-3030
Mailing Address - Fax:
Practice Address - Street 1:3106 CATCAY DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78418-2910
Practice Address - Country:US
Practice Address - Phone:361-446-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1113330225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist