Provider Demographics
NPI:1831305093
Name:YU, ROMMEL TAN (PT)
Entity Type:Individual
Prefix:
First Name:ROMMEL
Middle Name:TAN
Last Name:YU
Suffix:
Gender:M
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:PO BOX 290699
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-0699
Mailing Address - Country:US
Mailing Address - Phone:386-256-8745
Mailing Address - Fax:
Practice Address - Street 1:4606 S CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE 1-D
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-6404
Practice Address - Country:US
Practice Address - Phone:386-492-2986
Practice Address - Fax:386-492-2987
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5568225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist