Provider Demographics
NPI:1548591407
Name:REROMA, MARIA NOLEEN (PT)
Entity Type:Individual
Prefix:
First Name:MARIA NOLEEN
Middle Name:
Last Name:REROMA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7030 N SHERIDAN RD
Mailing Address - Street 2:APT 3M
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-3045
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7030 N SHERIDAN RD
Practice Address - Street 2:APT 3M
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-3045
Practice Address - Country:US
Practice Address - Phone:407-432-8764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017488225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist