Provider Demographics
NPI:1386602688
Name:JOYNER, ROSCOE WAYLON III (LPT)
Entity type:Individual
Prefix:
First Name:ROSCOE
Middle Name:WAYLON
Last Name:JOYNER
Suffix:III
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:ROSCOE
Other - Middle Name:W
Other - Last Name:JOYNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPT
Mailing Address - Street 1:110 PELICAN POINTE DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-7764
Mailing Address - Country:US
Mailing Address - Phone:252-338-4099
Mailing Address - Fax:252-338-4096
Practice Address - Street 1:806 W EHRINGHAUS ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-6935
Practice Address - Country:US
Practice Address - Phone:252-338-4099
Practice Address - Fax:252-338-4096
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1080225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC079UPOtherBCBS
NC079UPOtherBCBS