Provider Demographics
NPI:1669729448
Name:ZARA, ROMEO ZANTUA
Entity type:Individual
Prefix:
First Name:ROMEO
Middle Name:ZANTUA
Last Name:ZARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 PENNA RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-5014
Mailing Address - Country:US
Mailing Address - Phone:315-746-0767
Mailing Address - Fax:
Practice Address - Street 1:225 WATER ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13901-2704
Practice Address - Country:US
Practice Address - Phone:315-746-0767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-10
Last Update Date:2024-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist