Provider Demographics
NPI:1922091883
Name:SEAL, ROMA S (PT)
Entity type:Individual
Prefix:
First Name:ROMA
Middle Name:S
Last Name:SEAL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ROMA
Other - Middle Name:S
Other - Last Name:KRUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:21806 103RD AVENUE CT E
Practice Address - Street 2:#202
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338-8115
Practice Address - Country:US
Practice Address - Phone:253-847-3700
Practice Address - Fax:253-847-9622
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003505225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8931531OtherCRIME VICTIMS
WA3542SEOtherREGENCE B/S
WA178354OtherDEPT OF L&I
WA8379356Medicaid
WA8379356Medicaid