Provider Demographics
NPI:1073867800
Name:ROMBERG, GREG GREGORY
Entity Type:Individual
Prefix:MR
First Name:GREG
Middle Name:GREGORY
Last Name:ROMBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GREG
Other - Middle Name:GREGORY
Other - Last Name:ROMBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:312 S 6TH AVE W
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IA
Mailing Address - Zip Code:50208-4615
Mailing Address - Country:US
Mailing Address - Phone:641-831-9457
Mailing Address - Fax:
Practice Address - Street 1:2435 TECH CENTER PKWY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-1311
Practice Address - Country:US
Practice Address - Phone:770-623-9143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03226225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist