Provider Demographics
NPI:1154356913
Name:ROMERO, KEVIN MARK (ATC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:MARK
Last Name:ROMERO
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2513 N CURTIS DR
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-7068
Mailing Address - Country:US
Mailing Address - Phone:337-374-4180
Mailing Address - Fax:337-374-4399
Practice Address - Street 1:2513 N CURTIS DR
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-7068
Practice Address - Country:US
Practice Address - Phone:337-374-4180
Practice Address - Fax:337-374-4399
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAJ002542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer