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NPI Code Detail

MEDICARE: CHARLOTTE ROY PT

MEDICARE: CHARLOTTE ROY 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
1174400000XSpecialistPT-184ID

General Provider Information

NPI Number : 1356592737
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLOTTE ROY PT
Provider Business Mailing Address
First Line : 6855 W FAIRVIEW AVE STE 120
Second Line :
City : BOISE
State : ID
Zip : 83704-8046
Country : US
Telephone Number : 208-323-8888
Fax Number : 208-323-8889
Provider Business Practice Location Address
First Line : 6855 W FAIRVIEW AVE STE 120
Second Line :
City : BOISE
State : ID
Zip : 83704-8046
Country : US
Telephone Number : 208-323-8888
Fax Number : 208-323-8889
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2008
Last Update Date : 10/03/2008

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Directions to “ CHARLOTTE ROY PT” Practice Location

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