Provider Demographics
NPI:1750794483
Name:ROMANCIK, JAMIE NICOLE (DPT)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:NICOLE
Last Name:ROMANCIK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:JAMIE
Other - Middle Name:NICOLE
Other - Last Name:SCHROTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:7367 BERRY TRL
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:PA
Mailing Address - Zip Code:16415-3321
Mailing Address - Country:US
Mailing Address - Phone:814-860-1099
Mailing Address - Fax:
Practice Address - Street 1:4500 PINE AVE
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16504-2316
Practice Address - Country:US
Practice Address - Phone:814-825-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0050102255A2300X
PAPT023589225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1029502730009Medicaid
PAPENDINGOtherPA PROMISE
PA12704342OtherCAQH
PA12704342OtherCAQH
PA356667NJTMedicare PIN