Provider Demographics
NPI:1407377658
Name:ROME, ETHAN (DPT)
Entity type:Individual
Prefix:
First Name:ETHAN
Middle Name:
Last Name:ROME
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1263 WHITE TAIL PATH
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-9105
Mailing Address - Country:US
Mailing Address - Phone:504-559-0218
Mailing Address - Fax:
Practice Address - Street 1:35 PARRIS ISLAND GTWY UNIT 198
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29906-4244
Practice Address - Country:US
Practice Address - Phone:843-575-4722
Practice Address - Fax:843-459-7904
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-28
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT32565225100000X
SCPT9384225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist