Provider Demographics
NPI:1255716254
Name:ROMO, RENEE (MA, LAT, ATC)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:ROMO
Suffix:
Gender:F
Credentials:MA, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23407 61ST AVE S
Mailing Address - Street 2:Z202
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-1853
Mailing Address - Country:US
Mailing Address - Phone:909-731-9206
Mailing Address - Fax:
Practice Address - Street 1:23407 61ST AVE S
Practice Address - Street 2:Z202
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-1853
Practice Address - Country:US
Practice Address - Phone:909-731-9206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer