=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780394270
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROYAL THERAPY SERVICES PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/25/2022
-----------------------------------------------------
Last Update Date | 11/25/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 117 5TH AVE SW UNIT 56
-----------------------------------------------------
City | MINOT
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58701-9998
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-721-3722
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 56
-----------------------------------------------------
City | MINOT
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58702-0056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-721-3722
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | CASSIE SHEPPARD
-----------------------------------------------------
Credential | CCC-SLP
-----------------------------------------------------
Telephone | 701-721-3722
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------