Provider Demographics
NPI:1194802421
Name:ROY, CHARLES K (PT)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:K
Last Name:ROY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2217
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22604-1417
Mailing Address - Country:US
Mailing Address - Phone:540-667-8975
Mailing Address - Fax:540-504-8205
Practice Address - Street 1:130 MEDICAL CIR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3322
Practice Address - Country:US
Practice Address - Phone:540-667-7076
Practice Address - Fax:540-667-5773
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV000684174400000X
VA2305003386174400000X, 225100000X
WV0156640000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0156640000Medicaid
VA3810004945Medicaid
WV0156640000Medicaid
VA650000239Medicare PIN
VAQ49464AMedicare PIN