Healthcare Provider Details

I. General information

NPI: 1861327249
Provider Name (Legal Business Name): BROOKE LYNN ROYSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 W TIETAN ST
WALLA WALLA WA
99362-4363
US

IV. Provider business mailing address

80 BLACKBERRY LN
WALLA WALLA WA
99362-8643
US

V. Phone/Fax

Practice location:
  • Phone: 509-522-0114
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number70130296
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: