MEDICARE: SARAH E ROME DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	NJ QA01026600	NJ

General Provider Information

NPI Number	:	1063463107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH E ROME DPT

Provider Business Mailing Address
First Line	:	4175 VETERANS MEMORIAL HWY
Second Line	:	SUITE 202
City	:	RONKONKOMA
State	:	NY
Zip	:	11779-7639
Country	:	US
Telephone Number	:	631-580-5200
Fax Number	:	631-580-5222

Provider Business Practice Location Address
First Line	:	452 US HWY RTE 206
Second Line	:
City	:	MONTAGUE
State	:	NJ
Zip	:	07827
Country	:	US
Telephone Number	:	973-293-0010
Fax Number	:	973-293-0018

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2006
Last Update Date	:	11/10/2009

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Directions to “ SARAH E ROME DPT” Practice Location

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