Provider Demographics
NPI:1336213602
Name:ROMERO, JOHN A (PT MA SCS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:ROMERO
Suffix:
Gender:M
Credentials:PT MA SCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10605 CONCORD STREET
Mailing Address - Street 2:SUITE 105
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895
Mailing Address - Country:US
Mailing Address - Phone:301-946-7717
Mailing Address - Fax:301-989-0939
Practice Address - Street 1:10605 CONCORD STREET
Practice Address - Street 2:SUITE 105
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895
Practice Address - Country:US
Practice Address - Phone:301-946-7717
Practice Address - Fax:301-989-0939
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14857225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD184989BBBMedicare PIN