Provider Demographics
NPI:1073921110
Name:ROYLE, REBECCA M (DPT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:M
Last Name:ROYLE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:M
Other - Last Name:KATHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:325 S 1ST AVE
Mailing Address - Street 2:P.O. BOX 435
Mailing Address - City:BROKEN BOW
Mailing Address - State:NE
Mailing Address - Zip Code:68822-2213
Mailing Address - Country:US
Mailing Address - Phone:308-872-5111
Mailing Address - Fax:308-872-5115
Practice Address - Street 1:312 S 15TH ST
Practice Address - Street 2:
Practice Address - City:ORD
Practice Address - State:NE
Practice Address - Zip Code:68862-1708
Practice Address - Country:US
Practice Address - Phone:308-728-5755
Practice Address - Fax:308-728-5755
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3377225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE098562010Medicare PIN