Provider Demographics
NPI:1104949833
Name:ROMERO, PENNI JO (PT, MS)
Entity type:Individual
Prefix:
First Name:PENNI
Middle Name:JO
Last Name:ROMERO
Suffix:
Gender:F
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3460 PINEY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-4420
Mailing Address - Country:US
Mailing Address - Phone:402-289-0053
Mailing Address - Fax:
Practice Address - Street 1:3460 PINEY CREEK DR
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-4420
Practice Address - Country:US
Practice Address - Phone:402-289-0053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6202251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025210600Medicaid