Provider Demographics
NPI:1992818686
Name:BUCHOLTZ, RONALD SCOTT (MA, DPT, OCS)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:SCOTT
Last Name:BUCHOLTZ
Suffix:
Gender:M
Credentials:MA, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 GARFIELD AVE
Mailing Address - Street 2:200
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-3247
Mailing Address - Country:US
Mailing Address - Phone:304-865-6778
Mailing Address - Fax:304-865-7400
Practice Address - Street 1:1212 GARFIELD AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-3247
Practice Address - Country:US
Practice Address - Phone:304-865-6778
Practice Address - Fax:304-865-7400
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV002468225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2608548Medicaid
WV3810002649Medicaid
P00353841OtherRAILROAD MEDICARE
4151153Medicare PIN