Provider Demographics
NPI:1497309314
Name:ROMAN, TAMMY SUE
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:SUE
Last Name:ROMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:SUE
Other - Last Name:GILLESPIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 BREWSTER DR
Mailing Address - Street 2:
Mailing Address - City:IVYLAND
Mailing Address - State:PA
Mailing Address - Zip Code:18974-1786
Mailing Address - Country:US
Mailing Address - Phone:267-640-3474
Mailing Address - Fax:
Practice Address - Street 1:1425 HORSHAM RD
Practice Address - Street 2:
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-1320
Practice Address - Country:US
Practice Address - Phone:215-371-3689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE1000589225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant