Provider Demographics
NPI:1174859672
Name:ROMAN WARE, DORINA CARMEN (PT)
Entity Type:Individual
Prefix:
First Name:DORINA
Middle Name:CARMEN
Last Name:ROMAN WARE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DORINA
Other - Middle Name:CARMEN
Other - Last Name:ROMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 949
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162-0949
Mailing Address - Country:US
Mailing Address - Phone:912-729-1333
Mailing Address - Fax:912-729-5259
Practice Address - Street 1:100 A LINDSEY LANE
Practice Address - Street 2:
Practice Address - City:ST. MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-1727
Practice Address - Country:US
Practice Address - Phone:912-729-1333
Practice Address - Fax:912-729-5259
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT014529225100000X
OHPT012543225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist