Provider Demographics
NPI:1053625657
Name:ROMAN, ELENA (MSPT)
Entity type:Individual
Prefix:MISS
First Name:ELENA
Middle Name:
Last Name:ROMAN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARR. 844 VILLAS DEL MONTE
Mailing Address - Street 2:APT. 2A3 BOX 11
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-531-0091
Mailing Address - Fax:
Practice Address - Street 1:CARR. 844 VILLAS DEL MONTE
Practice Address - Street 2:APT 2A3 BOX 11
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-531-0091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-06
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1405225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist