Provider Demographics
NPI:1366231441
Name:SMITH, RONALD (PTA)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:SMITH
Suffix:
Gender:
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:492 MADISON AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409
Mailing Address - Country:US
Mailing Address - Phone:708-238-6006
Mailing Address - Fax:
Practice Address - Street 1:2350 TAFT ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46404-3349
Practice Address - Country:US
Practice Address - Phone:219-669-8708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant