Individual provider Active NPI

Molly Nicole Romaniak, DPT

  • Physical Therapist
  • Chicago, IL
National Provider Identifier
1942936935
Registry record updated Aug 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
12830636-2401 Issued in UT
Practice address
2157 N Damen Ave Ste 2C
Chicago, IL 60647-6916
Phone
(773) 278-4769
NPI assigned
Aug 1, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 12830636-2401 UT Primary

Addresses

Primary practice location

2157 N Damen Ave Ste 2C
Chicago, IL 60647-6916

Mailing address

232 Swanton Rd
Madison, WI 53714-1921
Phone (608) 358-2624

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
12830636-2401UTMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Kids on the Grow Physical Therapist CurrentSince Aug 7, 2022 Accepting new patients
Let'S Grow, Inc. CurrentSince Jun 30, 2024 Accepting new patients

Locations

2157 N Damen Ave
Ste 2C
Chicago, IL 60647
Phone (773) 278-4769

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1659312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659312000000",
    "number": "1942936935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "232 SWANTON RD",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537141921",
            "telephone_number": "608-358-2624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2157 N DAMEN AVE STE 2C",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606476916",
            "telephone_number": "773-278-4769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROMANIAK",
        "first_name": "MOLLY",
        "middle_name": "NICOLE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-01",
        "last_updated": "2022-08-01",
        "certification_date": "2022-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "UT",
            "license": "12830636-2401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.