Provider Demographics
NPI:1649235573
Name:ROMER, MINDI JO (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:MINDI
Middle Name:JO
Last Name:ROMER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 383
Mailing Address - Street 2:
Mailing Address - City:HALSEY
Mailing Address - State:OR
Mailing Address - Zip Code:97348-0383
Mailing Address - Country:US
Mailing Address - Phone:541-990-8444
Mailing Address - Fax:
Practice Address - Street 1:287 W J ST
Practice Address - Street 2:
Practice Address - City:HALSEY
Practice Address - State:OR
Practice Address - Zip Code:97348-0383
Practice Address - Country:US
Practice Address - Phone:541-990-8444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4360225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist