Provider Demographics
NPI:1902975329
Name:ROMAN, NELSON (DPT)
Entity Type:Individual
Prefix:MR
First Name:NELSON
Middle Name:
Last Name:ROMAN
Suffix:
Gender:M
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:PMB 103
Mailing Address - Street 2:425 CARR. 693 STE 1
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-9817
Mailing Address - Country:US
Mailing Address - Phone:787-262-3007
Mailing Address - Fax:787-854-7021
Practice Address - Street 1:CLINICAL LAS VEGAS
Practice Address - Street 2:CARR #2 KM 46.4 EDIF. LAS VEGAS 420
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-854-7021
Practice Address - Fax:787-854-7021
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1212174400000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR039100100Medicaid