Provider Demographics
NPI:1164029112
Name:ROMERO, TAMA A (LMT)
Entity Type:Individual
Prefix:
First Name:TAMA
Middle Name:A
Last Name:ROMERO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 DUNCAN DR NW # 803
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-3513
Mailing Address - Country:US
Mailing Address - Phone:678-570-9503
Mailing Address - Fax:
Practice Address - Street 1:3005 SHIRLEY DR NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-2843
Practice Address - Country:US
Practice Address - Phone:678-570-9503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA009644225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist