Provider Demographics
NPI:1750002770
Name:ROMAN, MARISSA (DPT)
Entity type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:
Last Name:ROMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 GINA DR
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-6348
Mailing Address - Country:US
Mailing Address - Phone:512-739-6027
Mailing Address - Fax:
Practice Address - Street 1:651 N BUSINESS IH 35 STE 415
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-7874
Practice Address - Country:US
Practice Address - Phone:830-515-5727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1368265225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist