Provider Demographics
NPI:1710287131
Name:ROMERO, OSA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:OSA
Middle Name:
Last Name:ROMERO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 SW 83RD TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-1451
Mailing Address - Country:US
Mailing Address - Phone:352-328-1655
Mailing Address - Fax:
Practice Address - Street 1:220 N MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:CHIEFLAND
Practice Address - State:FL
Practice Address - Zip Code:32626-0802
Practice Address - Country:US
Practice Address - Phone:352-490-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-01
Last Update Date:2010-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21952225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant