Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 620 | NE |
NPI | 1104949833 |
---|---|
Provider Name | Penni Jo Romero |
First Address | Elkhorn, NE 68022-4420 |
Second Address | Elkhorn, NE 68022-4420 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2007 |
Last Update Date | 21/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10025210600 | (05) | NE |