Basic Information
Provider Information
NPI: 1164549275
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROMMEL
FirstName: KRISTEN
MiddleName: BRICKER
NamePrefix: MRS.
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5530 WISCONSIN AVE
Address2: #1650
City: CHEVY CHASE
State: MD
PostalCode: 20815
CountryCode: US
TelephoneNumber: 3019869100
FaxNumber: 3019869101
Practice Location
Address1: 5530 WISCONSIN AVE
Address2: #1650
City: CHEVY CHASE
State: MD
PostalCode: 20815
CountryCode: US
TelephoneNumber: 3019869100
FaxNumber: 3019869101
Other Information
ProviderEnumerationDate: 03/23/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X20402MDY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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