Provider Demographics
NPI:1669428413
Name:ROMAINE, DAVID T (PT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:T
Last Name:ROMAINE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 MILLBURN AVE
Mailing Address - Street 2:MCRC PHYSICAL THERAPY
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1825
Mailing Address - Country:US
Mailing Address - Phone:973-376-7100
Mailing Address - Fax:973-376-7101
Practice Address - Street 1:42 FAIRFIELD PL
Practice Address - Street 2:
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-6212
Practice Address - Country:US
Practice Address - Phone:973-227-8585
Practice Address - Fax:973-227-8575
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40 QA01098800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist