Provider Demographics
NPI:1316084718
Name:ROMANO, MICHELLE ANGELA (MPT)
Entity type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:ANGELA
Last Name:ROMANO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3596 PEBBLE PATH LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-1614
Mailing Address - Country:US
Mailing Address - Phone:850-339-5979
Mailing Address - Fax:
Practice Address - Street 1:251 E FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-8303
Practice Address - Country:US
Practice Address - Phone:321-725-3990
Practice Address - Fax:321-725-4099
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2008-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22894225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist