MEDICARE: MRS. TEATHER LYNNE ROYSE PA-C

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	363AM0700X	Medical Physician Assistant	MA002715L	PA

General Provider Information

NPI Number	:	1851433908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TEATHER LYNNE ROYSE PA-C

Provider Business Mailing Address
First Line	:	1605 N CEDAR CREST BLVD
Second Line	:	STE. 110B
City	:	ALLENTOWN
State	:	PA
Zip	:	18104-2351
Country	:	US
Telephone Number	:	610-973-1410
Fax Number	:	610-973-1449

Provider Business Practice Location Address
First Line	:	6081 HAMILTON BLVD STE 101
Second Line	:
City	:	WESCOSVILLE
State	:	PA
Zip	:	18106-9801
Country	:	US
Telephone Number	:	610-841-4404
Fax Number	:	484-403-4026

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	10/04/2017

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