Provider Demographics
NPI:1265559348
Name:GILLIM ROMANO, RENEE (PT)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:GILLIM ROMANO
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 1:16275 LOS GATOS BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-4519
Mailing Address - Country:US
Mailing Address - Phone:408-402-0210
Mailing Address - Fax:408-402-0710
Practice Address - Street 1:16275 LOS GATOS BLVD
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-4519
Practice Address - Country:US
Practice Address - Phone:408-402-0210
Practice Address - Fax:408-402-0710
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT16560225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist