MEDICARE: GRETCHEN ROMAN PT

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	018918	NY
2	225100000X	Physical Therapist	018918	NY

General Provider Information

NPI Number	:	1912978651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRETCHEN ROMAN PT

Provider Business Mailing Address
First Line	:	140 OFFICE PARK WAY
Second Line	:
City	:	PITTSFORD
State	:	NY
Zip	:	14534-1758
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 OFFICE PARK WAY
Second Line	:
City	:	PITTSFORD
State	:	NY
Zip	:	14534-1758
Country	:	US
Telephone Number	:	585-387-7180
Fax Number	:

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

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	07/01/2008

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Directions to “ GRETCHEN ROMAN PT” Practice Location

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