Provider Demographics
NPI:1790168094
Name:ROMAN, JODI L (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:L
Last Name:ROMAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1191 WOODSTOCK DR UNIT 2
Mailing Address - Street 2:
Mailing Address - City:ESTES PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80517-5414
Mailing Address - Country:US
Mailing Address - Phone:970-236-2535
Mailing Address - Fax:970-236-2568
Practice Address - Street 1:1191 WOODSTOCK DR UNIT 2
Practice Address - Street 2:
Practice Address - City:ESTES PARK
Practice Address - State:CO
Practice Address - Zip Code:80517-5414
Practice Address - Country:US
Practice Address - Phone:970-236-2535
Practice Address - Fax:970-236-2568
Is Sole Proprietor?:No
Enumeration Date:2015-07-06
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0013320225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist