Provider Demographics
NPI:1841881851
Name:ROMERO, LUIS ALONSO (PTA)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:ALONSO
Last Name:ROMERO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 POINTE SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:RANDLEMAN
Mailing Address - State:NC
Mailing Address - Zip Code:27317-9520
Mailing Address - Country:US
Mailing Address - Phone:336-799-4435
Mailing Address - Fax:
Practice Address - Street 1:148 POINTE SOUTH DRIVE
Practice Address - Street 2:
Practice Address - City:RANDLEMAN
Practice Address - State:NC
Practice Address - Zip Code:27317-9520
Practice Address - Country:US
Practice Address - Phone:336-799-4435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA6807225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant