Provider Demographics
NPI:1497469639
Name:RACOS, ROMEO (DPT)
Entity Type:Individual
Prefix:
First Name:ROMEO
Middle Name:
Last Name:RACOS
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 1:32 PEARSALL AVE APT 1E
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-3011
Mailing Address - Country:US
Mailing Address - Phone:516-424-9089
Mailing Address - Fax:
Practice Address - Street 1:32 PEARSALL AVE APT 1E
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-3011
Practice Address - Country:US
Practice Address - Phone:516-424-9089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046789-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist