Healthcare Provider Details

I. General information

NPI: 1144499146
Provider Name (Legal Business Name): LEON C ROMERO PT, DSC, OCS, ECS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 03/31/2020
Certification Date: 03/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2336 WISTERIA DR STE 420
SNELLVILLE GA
30078-6160
US

IV. Provider business mailing address

PO BOX 1566
SNELLVILLE GA
30078-1566
US

V. Phone/Fax

Practice location:
  • Phone: 404-590-5366
  • Fax: 770-982-0015
Mailing address:
  • Phone: 404-590-5366
  • Fax: 770-982-0015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT008390
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT008390
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License NumberPT008390
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: