Provider Demographics
NPI:1063774974
Name:ROMAN, MARCIA REGINA (PT, CLT, WCC)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:REGINA
Last Name:ROMAN
Suffix:
Gender:F
Credentials:PT, CLT, WCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 NOBLE ST
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-6136
Mailing Address - Country:US
Mailing Address - Phone:407-463-8044
Mailing Address - Fax:407-386-7878
Practice Address - Street 1:301 N HIGHWAY 27
Practice Address - Street 2:SUITE F
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2447
Practice Address - Country:US
Practice Address - Phone:352-432-3910
Practice Address - Fax:352-432-3911
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 8353225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist