Provider Demographics
NPI:1174532105
Name:ROMO, JAMES WALLACE (PT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:WALLACE
Last Name:ROMO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11711 NE 12TH ST
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005
Mailing Address - Country:US
Mailing Address - Phone:425-450-9474
Mailing Address - Fax:425-452-0704
Practice Address - Street 1:3131 SMOKEY POINT DRIVE
Practice Address - Street 2:SUITE G
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223
Practice Address - Country:US
Practice Address - Phone:360-658-8400
Practice Address - Fax:360-658-2606
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPT00006894225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7101058Medicaid
AB14915Medicare ID - Type Unspecified