Provider Demographics
NPI:1114681392
Name:ROMERO, NICHOLAS ADAM (DPT)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ADAM
Last Name:ROMERO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:NICK
Other - Middle Name:
Other - Last Name:ROMERO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:5300 ANTEQUERA RD NW APT 2306
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-4592
Mailing Address - Country:US
Mailing Address - Phone:505-979-1196
Mailing Address - Fax:
Practice Address - Street 1:4101 PASEO DEL NORTE NE # 118
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-2620
Practice Address - Country:US
Practice Address - Phone:505-503-8376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPT59582251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic