Provider Demographics
NPI:1134397425
Name:ROMAN, AMANDA MARIE (PTA)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MARIE
Last Name:ROMAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:MARIE
Other - Last Name:SHEPARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:117 ORVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21221-1309
Mailing Address - Country:US
Mailing Address - Phone:410-686-2270
Mailing Address - Fax:410-686-5447
Practice Address - Street 1:2021 EMMORTON RD
Practice Address - Street 2:SUITE 110-114 BUILDING A
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-6138
Practice Address - Country:US
Practice Address - Phone:410-515-0006
Practice Address - Fax:410-515-0027
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA2648225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant