MEDICARE: ROYCE PHYSICAL THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	20140016DC	ME

General Provider Information

NPI Number	:	1720429780
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROYCE PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	PO BOX 164
Second Line	:
City	:	RANGELEY
State	:	ME
Zip	:	04970-0164
Country	:	US
Telephone Number	:	207-670-6708
Fax Number	:

Provider Business Practice Location Address
First Line	:	1409 RANGELEY RD
Second Line	:
City	:	LANG TWP
State	:	ME
Zip	:	04970-5001
Country	:	US
Telephone Number	:	207-670-6708
Fax Number	:

Authorized Official
Title or Position	:	OWNER, PHYSICAL THERAPIST
Name	:	LIZA ROGERS
Credential	:	MPT, ATC
Telephone Number	:	207-670-6708

Provider Enumeration Date	:	07/08/2013
Last Update Date	:	07/24/2013

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Directions to “ROYCE PHYSICAL THERAPY ” Practice Location

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