Provider Demographics
NPI:1447541909
Name:VANWILLIGEN, RONA H (PT)
Entity type:Individual
Prefix:MRS
First Name:RONA
Middle Name:H
Last Name:VANWILLIGEN
Suffix:
Gender:F
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:PO BOX 883
Mailing Address - Street 2:
Mailing Address - City:SANDIA PARK
Mailing Address - State:NM
Mailing Address - Zip Code:87047-0883
Mailing Address - Country:US
Mailing Address - Phone:505-281-8463
Mailing Address - Fax:505-281-8469
Practice Address - Street 1:1851 HIGHWAY 333
Practice Address - Street 2:2-B
Practice Address - City:EDGEWOOD
Practice Address - State:NM
Practice Address - Zip Code:87015
Practice Address - Country:US
Practice Address - Phone:505-281-8463
Practice Address - Fax:505-281-8469
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3833225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist