Provider Demographics
NPI:1164440244
Name:ROMAIN, BRUCE (ATC/LAT)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:
Last Name:ROMAIN
Suffix:
Gender:M
Credentials:ATC/LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1957 LARKDALE DR
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-4207
Mailing Address - Country:US
Mailing Address - Phone:847-729-4006
Mailing Address - Fax:847-424-7702
Practice Address - Street 1:1600 DODGE AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3449
Practice Address - Country:US
Practice Address - Phone:847-424-7700
Practice Address - Fax:847-424-7702
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer