Provider Demographics
NPI:1972537272
Name:BABCOCK, RONALD WAYNE JR (PT)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:WAYNE
Last Name:BABCOCK
Suffix:JR
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 1:61765 STONEHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850
Mailing Address - Country:US
Mailing Address - Phone:541-962-9529
Mailing Address - Fax:541-975-2720
Practice Address - Street 1:61765 STONE HAVEN LN
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-9505
Practice Address - Country:US
Practice Address - Phone:541-962-9529
Practice Address - Fax:541-975-2720
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3765225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR103240Medicare ID - Type UnspecifiedMEDICARE IDENTIFYER