Provider Demographics
NPI:1336705516
Name:CADORNA, ROMMEL PATRICK BROWN (RPT)
Entity Type:Individual
Prefix:
First Name:ROMMEL PATRICK
Middle Name:BROWN
Last Name:CADORNA
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49872 ALDEN
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-2869
Mailing Address - Country:US
Mailing Address - Phone:734-219-8740
Mailing Address - Fax:
Practice Address - Street 1:3999 VENOY RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-1485
Practice Address - Country:US
Practice Address - Phone:734-727-0440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010151302251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
5501015130OtherLARA , STATE OF MICHIGAN