Provider Demographics
NPI:1053765743
Name:ROM PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:ROM PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ATILANO MANUELITO
Authorized Official - Middle Name:MENDOZA
Authorized Official - Last Name:MANALESE
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:248-308-8215
Mailing Address - Street 1:28679 BAYBERRY CT E
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-3869
Mailing Address - Country:US
Mailing Address - Phone:248-308-8215
Mailing Address - Fax:
Practice Address - Street 1:28679 BAYBERRY CT E
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-3869
Practice Address - Country:US
Practice Address - Phone:248-308-8215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011779261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy