MEDICARE: MR. STEVE S ROYLANCE PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT00006463	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346322336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEVE S ROYLANCE PT

Provider Business Mailing Address
First Line	:	824 W LEWIS ST STE 204
Second Line	:
City	:	PASCO
State	:	WA
Zip	:	99301-5561
Country	:	US
Telephone Number	:	509-544-0265
Fax Number	:	509-544-0304

Provider Business Practice Location Address
First Line	:	1342 S PIONEER WAY
Second Line	:
City	:	MOSES LAKE
State	:	WA
Zip	:	98837-2410
Country	:	US
Telephone Number	:	509-765-9608
Fax Number	:	509-766-0481

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	10/03/2007

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