MEDICARE: JERRY ROMANS

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	320700000X	Physical Disabilities Residential Treatment Facility		TX

General Provider Information

NPI Number	:	1700065125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERRY ROMANS

Provider Business Mailing Address
First Line	:	5012 TRINITY LANDING DR W
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3736
Country	:	US
Telephone Number	:	817-701-8642
Fax Number	:

Provider Business Practice Location Address
First Line	:	5012 TRINITY LANDING DR W
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3736
Country	:	US
Telephone Number	:	817-701-8642
Fax Number	:

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

Provider Enumeration Date	:	11/01/2007
Last Update Date	:	11/01/2007

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Directions to “ JERRY ROMANS ” Practice Location

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