Healthcare Provider Details

I. General information

NPI: 1346442027
Provider Name (Legal Business Name): MARY LYNNE ROMANIC-FEDOR DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3045 PENNSYLVANIA AVE SUITE 8
WEIRTON WV
26062-3770
US

IV. Provider business mailing address

PO BOX 15
BYRNEDALE PA
15827-0015
US

V. Phone/Fax

Practice location:
  • Phone: 304-723-7111
  • Fax: 304-723-7173
Mailing address:
  • Phone: 412-780-6417
  • Fax: 304-723-7173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT2633
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number011190
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: