Provider Demographics
NPI:1528691532
Name:ROMANO, STEPHANIE MARY (PTA)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:MARY
Last Name:ROMANO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:MARY
Other - Last Name:ROMANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:15 PHANEUF ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01949-2315
Mailing Address - Country:US
Mailing Address - Phone:978-854-2681
Mailing Address - Fax:
Practice Address - Street 1:15 PHANEUF ST
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:MA
Practice Address - Zip Code:01949-2315
Practice Address - Country:US
Practice Address - Phone:978-854-2681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7878225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant