Provider Demographics
NPI:1962567602
Name:DANIELS, RONALD KOLBY (MHS, PT)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:KOLBY
Last Name:DANIELS
Suffix:
Gender:M
Credentials:MHS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1664 S DIXIE DR STE L105
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-7331
Mailing Address - Country:US
Mailing Address - Phone:435-652-3707
Mailing Address - Fax:435-652-3750
Practice Address - Street 1:1664 S DIXIE DR STE L105
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-7331
Practice Address - Country:US
Practice Address - Phone:435-652-3707
Practice Address - Fax:435-652-3750
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT114459-24012251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT143150Medicare ID - Type UnspecifiedPPIN