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General NPI Number Information
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NPI Number | 1205106390
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Entity Type | Individual
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Provider Name | ROMOLA ANNE MADZIAR P.T.
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Gender | Female
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Dates
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Enumeration Date | 01/05/2012
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Last Update Date | 01/05/2012
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Provider Practice Location Address
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Address Line | 411 N WASHINGTON AVE SUITE 4000 LB 10
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City | DALLAS
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State | TX
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Zip | 75246-1713
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Country | US
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Telephone | 213-820-7597
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Fax |
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Provider Business Mailing Address
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Address Line | 411 N WASHINGTON AVE SUITE 4000 LB 10
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City | DALLAS
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State | TX
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Zip | 75246-1713
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Country | US
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Telephone | 213-820-7597
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1135747
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License Number State | TX
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