Healthcare Provider Details

I. General information

NPI: 1720429780
Provider Name (Legal Business Name): ROYCE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 07/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 RANGELEY RD
LANG TWP ME
04970-5001
US

IV. Provider business mailing address

PO BOX 164
RANGELEY ME
04970-0164
US

V. Phone/Fax

Practice location:
  • Phone: 207-670-6708
  • Fax:
Mailing address:
  • Phone: 207-670-6708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number20140016DC
License Number StateME

VIII. Authorized Official

Name: LIZA ROGERS
Title or Position: OWNER, PHYSICAL THERAPIST
Credential: MPT, ATC
Phone: 207-670-6708