Provider Demographics
NPI:1003185646
Name:ROMANO, RUSSELL (ATC)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:
Last Name:ROMANO
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:THE JOHN MCKAY CTR
Mailing Address - Street 2:940 WEST 35TH ST
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90089-0602
Mailing Address - Country:US
Mailing Address - Phone:213-761-6553
Mailing Address - Fax:213-740-0504
Practice Address - Street 1:THE JOHN MCKAY CTR
Practice Address - Street 2:940 WEST 35TH ST
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-0602
Practice Address - Country:US
Practice Address - Phone:213-761-6553
Practice Address - Fax:213-740-0504
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-28
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer