Healthcare Provider Details

I. General information

NPI: 1174532105
Provider Name (Legal Business Name): JAMES WALLACE ROMO PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 08/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 SMOKEY POINT DRIVE SUITE G
ARLINGTON WA
98223
US

IV. Provider business mailing address

11711 NE 12TH ST SUITE 3A
BELLEVUE WA
98005
US

V. Phone/Fax

Practice location:
  • Phone: 360-658-8400
  • Fax: 360-658-2606
Mailing address:
  • Phone: 425-450-9474
  • Fax: 425-452-0704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00006894
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: