Provider Demographics
NPI:1144499146
Name:ROMERO, LEON C (PT, DSC, OCS, ECS)
Entity type:Individual
Prefix:DR
First Name:LEON
Middle Name:C
Last Name:ROMERO
Suffix:
Gender:M
Credentials:PT, DSC, OCS, ECS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1566
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-1566
Mailing Address - Country:US
Mailing Address - Phone:404-590-5366
Mailing Address - Fax:770-982-0015
Practice Address - Street 1:2336 WISTERIA DR STE 420
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6160
Practice Address - Country:US
Practice Address - Phone:404-590-5366
Practice Address - Fax:770-982-0015
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-22
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008390225100000X, 2251X0800X, 2251E1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003175864AMedicaid
GA202I658450Medicare PIN