Provider Demographics
NPI:1386000446
Name:VROMAN, MARC (LMT)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:VROMAN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 N BOYER AVE
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1908
Mailing Address - Country:US
Mailing Address - Phone:208-946-1288
Mailing Address - Fax:
Practice Address - Street 1:102 S EUCLID AVE
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-4912
Practice Address - Country:US
Practice Address - Phone:208-946-1288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMASG-1420172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist