Healthcare Provider Details

I. General information

NPI: 1548591407
Provider Name (Legal Business Name): MARIA NOLEEN REROMA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7030 N SHERIDAN RD APT 3M
CHICAGO IL
60626-3045
US

IV. Provider business mailing address

7030 N SHERIDAN RD APT 3M
CHICAGO IL
60626-3045
US

V. Phone/Fax

Practice location:
  • Phone: 407-432-8764
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070017488
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: