Provider Demographics
NPI:1396289328
Name:FOX, ROMAN CHANCE (RECREATION THERAPIST)
Entity type:Individual
Prefix:MR
First Name:ROMAN
Middle Name:CHANCE
Last Name:FOX
Suffix:
Gender:M
Credentials:RECREATION THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16727 CARACARA CT
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34610-9011
Mailing Address - Country:US
Mailing Address - Phone:757-333-1112
Mailing Address - Fax:
Practice Address - Street 1:17502 FALLOWFIELD DR
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-5584
Practice Address - Country:US
Practice Address - Phone:757-333-1112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-09
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 26297225200000X
225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant