1316084718 NPI number — MISS MICHELLE ANGELA ROMANO MPT

Table of content: MISS MICHELLE ANGELA ROMANO MPT (NPI 1316084718)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316084718 NPI number — MISS MICHELLE ANGELA ROMANO MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROMANO
Provider First Name:
MICHELLE
Provider Middle Name:
ANGELA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316084718
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3596 PEBBLE PATH LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32224-1614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-339-5979
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
251 E FLORIDA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32901-8303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-725-3990
Provider Business Practice Location Address Fax Number:
321-725-4099
Provider Enumeration Date:
02/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT22894 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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