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NPI Code Detail

MEDICARE: MR. ROY CULVER JR. PTA

MEDICARE: MR. ROY CULVER JR. PTA
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
1225200000XPhysical Therapy Assistant

General Provider Information

NPI Number : 1770063653
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ROY CULVER JR. PTA
Provider Business Mailing Address
First Line : 8595 MEDICAL CENTER BLVD
Second Line :
City : PORT ARTHUR
State : TX
Zip : 77640-2428
Country : US
Telephone Number : 409-721-8600
Fax Number :
Provider Business Practice Location Address
First Line : 8595 MEDICAL CENTER BLVD
Second Line :
City : PORT ARTHUR
State : TX
Zip : 77640-2428
Country : US
Telephone Number : 409-721-8600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2018
Last Update Date : 08/20/2018

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