Provider Demographics
NPI:1336424274
Name:ROMANI, SUSAN (LMT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:ROMANI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13716 NW MILBURN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-5712
Mailing Address - Country:US
Mailing Address - Phone:503-380-9659
Mailing Address - Fax:
Practice Address - Street 1:7460 SW HUNZIKER ST
Practice Address - Street 2:SUITE H
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8244
Practice Address - Country:US
Practice Address - Phone:503-718-4155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18173225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist