Provider Demographics
NPI:1730312315
Name:ROMANELLO, MATTHEW JOSEPH (BA, PTA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JOSEPH
Last Name:ROMANELLO
Suffix:
Gender:M
Credentials:BA, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 CHESTNUT DR
Mailing Address - Street 2:
Mailing Address - City:MINFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45653-8646
Mailing Address - Country:US
Mailing Address - Phone:740-353-4060
Mailing Address - Fax:
Practice Address - Street 1:2274 MCDERMOTT POND CREEK RD
Practice Address - Street 2:
Practice Address - City:MCDERMOTT
Practice Address - State:OH
Practice Address - Zip Code:45652
Practice Address - Country:US
Practice Address - Phone:740-259-5314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA07252225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant