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Individual

MR. CHAD ROMANOFF

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
930 W SOUTHERN AVE, STE 101, MESA, AZ 85210-4938
(480) 835-0857
Mailing address
4621 E CHANDLER BLVD, STE 100, PHOENIX, AZ 85048-0425
(480) 893-6514

Taxonomy

Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
2504
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
556821
AZ
Enumeration date
01/30/2007
Last updated
07/08/2007
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