Provider Demographics
NPI:1164202883
Name:ROME, KRYSTALY AISHA
Entity Type:Individual
Prefix:
First Name:KRYSTALY
Middle Name:AISHA
Last Name:ROME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 RIVENDELL LN
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-2707
Mailing Address - Country:US
Mailing Address - Phone:267-310-7202
Mailing Address - Fax:
Practice Address - Street 1:727 RIVENDELL LN
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-2707
Practice Address - Country:US
Practice Address - Phone:267-310-7202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician