Individual
MR. RONALD DALE KNICKREHM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
2102 EAST EVANS AVENUE, SUITE 115, VALPARAISO, IN 46383-4096
(219) 476-0377
(219) 476-0388
Mailing address
1145 SWANSON DRIVE, LA PORTE, IN 46350
(219) 324-4106
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05001536A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000202146
ANTHEM
—
Enumeration date
10/06/2006
Last updated
07/08/2007
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