Provider Demographics
NPI:1043532112
Name:FINE, RONALD DAVID (CMT)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:DAVID
Last Name:FINE
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 E FIFTH ST
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-3011
Mailing Address - Country:US
Mailing Address - Phone:610-565-3922
Mailing Address - Fax:
Practice Address - Street 1:130 E FIFTH ST
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3011
Practice Address - Country:US
Practice Address - Phone:610-565-3922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA016136-00OtherNATIONAL CERTIFICATION BOARD FOR MASSAGE AND BODYWORK