Provider Demographics
NPI:1720504723
Name:ROMANOWSKI, ANDREA E (PTA)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:E
Last Name:ROMANOWSKI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:E
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:3063 38TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-4173
Mailing Address - Country:US
Mailing Address - Phone:718-932-1269
Mailing Address - Fax:
Practice Address - Street 1:3063 38TH ST STE B
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-4173
Practice Address - Country:US
Practice Address - Phone:718-932-1269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009920-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant