Provider Demographics
NPI:1205106390
Name:MADZIAR, ROMOLA ANNE (PT)
Entity type:Individual
Prefix:MS
First Name:ROMOLA
Middle Name:ANNE
Last Name:MADZIAR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 N WASHINGTON AVE
Mailing Address - Street 2:SUITE 4000 LB 10
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1713
Mailing Address - Country:US
Mailing Address - Phone:213-820-7597
Mailing Address - Fax:
Practice Address - Street 1:411 N WASHINGTON AVE
Practice Address - Street 2:SUITE 4000 LB 10
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1713
Practice Address - Country:US
Practice Address - Phone:213-820-7597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1135747225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist