Provider Demographics
NPI:1053075275
Name:ROMANUSKI, JACOB (PTA)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:ROMANUSKI
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 JENNINGS ST
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-1320
Mailing Address - Country:US
Mailing Address - Phone:570-704-7050
Mailing Address - Fax:
Practice Address - Street 1:2850 COLUMBINE RD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80221-7600
Practice Address - Country:US
Practice Address - Phone:303-433-0282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA.0015097208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation