Provider Demographics
NPI:1679236814
Name:SEGHEZZI, ROMAN GREGORY (DPT)
Entity Type:Individual
Prefix:
First Name:ROMAN
Middle Name:GREGORY
Last Name:SEGHEZZI
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 1:10250 PRARIE MEADOW CIR
Mailing Address - Street 2:#205
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134
Mailing Address - Country:US
Mailing Address - Phone:530-575-6983
Mailing Address - Fax:
Practice Address - Street 1:24300 E SMOKY HILL RD UNIT 126
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-1387
Practice Address - Country:US
Practice Address - Phone:303-680-1772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTLP.0000216225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist