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NPI Code Detail

MEDICARE: MELLET R ROMERO PT

MEDICARE: MELLET R ROMERO 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
1225100000XPhysical TherapistPT008003GA
2225100000XPhysical Therapist05621OR

General Provider Information

NPI Number : 1922254515
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELLET R ROMERO PT
Provider Business Mailing Address
First Line : 525 SE WASHINGTON ST
Second Line :
City : DALLAS
State : OR
Zip : 97338-2834
Country : US
Telephone Number : 503-623-8301
Fax Number :
Provider Business Practice Location Address
First Line : 525 SE WASHINGTON ST
Second Line :
City : DALLAS
State : OR
Zip : 97338-2834
Country : US
Telephone Number : 503-623-8301
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2008
Last Update Date : 12/27/2023

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