MEDICARE: MS. MARY LOU ROMANELLO PT, ATC

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	174400000X	Specialist	ATT 133 & PT 3794	OH

General Provider Information

NPI Number	:	1427078559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY LOU ROMANELLO PT, ATC

Provider Business Mailing Address
First Line	:	5640 MONICA CT
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-1856
Country	:	US
Telephone Number	:	513-451-0456
Fax Number	:	513-451-2547

Provider Business Practice Location Address
First Line	:	5701 DELHI RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45233-1669
Country	:	US
Telephone Number	:	513-244-4975
Fax Number	:	513-451-2547

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	07/08/2007

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