Provider Demographics
NPI:1780830216
Name:ROMERO, CHARMAINE (PT)
Entity Type:Individual
Prefix:
First Name:CHARMAINE
Middle Name:
Last Name:ROMERO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 DOUCET RD
Mailing Address - Street 2:SUITE A-2
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3444
Mailing Address - Country:US
Mailing Address - Phone:337-216-7758
Mailing Address - Fax:337-216-7787
Practice Address - Street 1:353 DOUCET RD
Practice Address - Street 2:SUITE A-2
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3444
Practice Address - Country:US
Practice Address - Phone:337-216-7758
Practice Address - Fax:337-216-7787
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01641225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist