Provider Demographics
NPI:1275141079
Name:ROMAN, DYLAN PETER (DPT)
Entity Type:Individual
Prefix:DR
First Name:DYLAN
Middle Name:PETER
Last Name:ROMAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:WILLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06279-1630
Mailing Address - Country:US
Mailing Address - Phone:860-966-2380
Mailing Address - Fax:
Practice Address - Street 1:255 RIVER RD
Practice Address - Street 2:
Practice Address - City:WILLINGTON
Practice Address - State:CT
Practice Address - Zip Code:06279-1630
Practice Address - Country:US
Practice Address - Phone:860-966-2380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT012388208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation