Provider Demographics
NPI:1720429780
Name:ROYCE PHYSICAL THERAPY
Entity type:Organization
Organization Name:ROYCE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, ATC
Authorized Official - Phone:207-670-6708
Mailing Address - Street 1:PO BOX 164
Mailing Address - Street 2:
Mailing Address - City:RANGELEY
Mailing Address - State:ME
Mailing Address - Zip Code:04970-0164
Mailing Address - Country:US
Mailing Address - Phone:207-670-6708
Mailing Address - Fax:
Practice Address - Street 1:1409 RANGELEY RD
Practice Address - Street 2:
Practice Address - City:LANG TWP
Practice Address - State:ME
Practice Address - Zip Code:04970-5001
Practice Address - Country:US
Practice Address - Phone:207-670-6708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-08
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME20140016DC261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy