Provider Demographics
NPI:1639318827
Name:ROMAN, TERESA (LMT)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:ROMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2485 RIVERVIEW ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97403-3213
Mailing Address - Country:US
Mailing Address - Phone:541-485-0789
Mailing Address - Fax:
Practice Address - Street 1:2485 RIVERVIEW ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97403-3213
Practice Address - Country:US
Practice Address - Phone:541-485-0789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6648174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist