Provider Demographics
NPI:1801004163
Name:RACOSAS, ROMEL ALFEREZ (MPT)
Entity Type:Individual
Prefix:MR
First Name:ROMEL
Middle Name:ALFEREZ
Last Name:RACOSAS
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5204 US HIGHWAY 17 S
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-9680
Mailing Address - Country:US
Mailing Address - Phone:252-636-5156
Mailing Address - Fax:
Practice Address - Street 1:2000 NEUSE BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-3449
Practice Address - Country:US
Practice Address - Phone:252-633-8020
Practice Address - Fax:252-636-5376
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT29084225100000X
NCP12941225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist