Provider Demographics
NPI:1942936935
Name:ROMANIAK, MOLLY NICOLE (DPT)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:NICOLE
Last Name:ROMANIAK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 SWANTON RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53714-1921
Mailing Address - Country:US
Mailing Address - Phone:608-358-2624
Mailing Address - Fax:
Practice Address - Street 1:2157 N DAMEN AVE STE 2C
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-6916
Practice Address - Country:US
Practice Address - Phone:773-278-4769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12830636-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist