Provider Demographics
NPI:1992131130
Name:ROY, MARGARET JOHNSON (RPT)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:JOHNSON
Last Name:ROY
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 NORTHTOWN DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-3047
Mailing Address - Country:US
Mailing Address - Phone:601-206-9195
Mailing Address - Fax:601-957-8391
Practice Address - Street 1:5958 ST. BERNARD AVE
Practice Address - Street 2:VISTA SHORES ASST. LIVING
Practice Address - City:NOW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-1324
Practice Address - Country:US
Practice Address - Phone:504-288-3737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08017225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1588759369Medicare UPIN