Healthcare Provider Details

I. General information

NPI: 1174088892
Provider Name (Legal Business Name): MICHAEL ROMIZA DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1246 HARCOURT AVE APT B
SEASIDE CA
93955-5417
US

IV. Provider business mailing address

1246 HARCOURT AVE APT B
SEASIDE CA
93955-5417
US

V. Phone/Fax

Practice location:
  • Phone: 831-320-0634
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number296312
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: