Provider Demographics
NPI:1619459609
Name:ROMERO, MIRA SHEENA (PT)
Entity Type:Individual
Prefix:
First Name:MIRA SHEENA
Middle Name:
Last Name:ROMERO
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 1:124 CHESTNUT DR
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06415-1422
Mailing Address - Country:US
Mailing Address - Phone:914-539-0751
Mailing Address - Fax:
Practice Address - Street 1:100 RANDOLPH RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-5637
Practice Address - Country:US
Practice Address - Phone:860-344-0353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040303225100000X
CT10053225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist