Provider Demographics
NPI:1417734864
Name:ROMANN, BENJAMIN (LMT, MMT)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:ROMANN
Suffix:
Gender:M
Credentials:LMT, MMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 E MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-1968
Mailing Address - Country:US
Mailing Address - Phone:860-517-8885
Mailing Address - Fax:860-517-8884
Practice Address - Street 1:103 E MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-1968
Practice Address - Country:US
Practice Address - Phone:860-517-8885
Practice Address - Fax:860-517-8884
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9653225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist