Healthcare Provider Details

I. General information

NPI: 1265455570
Provider Name (Legal Business Name): KAREN WORTH ROYALL DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 08/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 FORDHAM DR
VIRGINIA BEACH VA
23464-5368
US

IV. Provider business mailing address

218 51ST ST
VIRGINIA BEACH VA
23451-2428
US

V. Phone/Fax

Practice location:
  • Phone: 757-361-3951
  • Fax: 757-361-3957
Mailing address:
  • Phone: 757-647-5107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305002708
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: