Provider Demographics
NPI:1851078752
Name:GASTALI, ROMANO
Entity Type:Individual
Prefix:
First Name:ROMANO
Middle Name:
Last Name:GASTALI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4222 N 163RD AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-2919
Mailing Address - Country:US
Mailing Address - Phone:402-753-7230
Mailing Address - Fax:
Practice Address - Street 1:610 E YORK RD
Practice Address - Street 2:
Practice Address - City:AVOCA
Practice Address - State:IA
Practice Address - Zip Code:51521-2052
Practice Address - Country:US
Practice Address - Phone:712-343-6398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IACP022194T225100000X
NE4495225100000X
MOCP022539T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist