Provider Demographics
NPI:1972168987
Name:RANGER, RODNEY P
Entity type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:P
Last Name:RANGER
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ROD
Other - Middle Name:
Other - Last Name:RANGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:4576 BLACK BEAR DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49685-7343
Mailing Address - Country:US
Mailing Address - Phone:231-357-9904
Mailing Address - Fax:
Practice Address - Street 1:1650 BARLOW ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-4721
Practice Address - Country:US
Practice Address - Phone:231-941-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501009269225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist