Provider Demographics
NPI:1346442027
Name:ROMANIC-FEDOR, MARY LYNNE (DPT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LYNNE
Last Name:ROMANIC-FEDOR
Suffix:
Gender:F
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:PO BOX 15
Mailing Address - Street 2:
Mailing Address - City:BYRNEDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15827-0015
Mailing Address - Country:US
Mailing Address - Phone:412-780-6417
Mailing Address - Fax:304-723-7173
Practice Address - Street 1:3045 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-3770
Practice Address - Country:US
Practice Address - Phone:304-723-7111
Practice Address - Fax:304-723-7173
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT2633225100000X
OH011190225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist