Healthcare Provider Details

I. General information

NPI: 1376877415
Provider Name (Legal Business Name): PAUL ROYER RN LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2009
Last Update Date: 09/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 PORTAGE TRAIL EXT
AKRON OH
44313-8250
US

IV. Provider business mailing address

15123 PORTAGE ST
DOYLESTOWN OH
44230-1126
US

V. Phone/Fax

Practice location:
  • Phone: 330-608-0490
  • Fax: 330-658-6868
Mailing address:
  • Phone: 330-608-0490
  • Fax: 330-658-6868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License Number178178
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33007573
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: