Provider Demographics
NPI:1164820791
Name:ROYCE, DANIELLE THIBODEAUX
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:THIBODEAUX
Last Name:ROYCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 PATRICIA LN
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-1433
Mailing Address - Country:US
Mailing Address - Phone:832-926-3319
Mailing Address - Fax:
Practice Address - Street 1:1717 PATRICIA LN
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-1433
Practice Address - Country:US
Practice Address - Phone:832-926-3319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-13
Last Update Date:2014-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1400920174400000X, 174H00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No174H00000XOther Service ProvidersHealth Educator
No335E00000XSuppliersProsthetic/Orthotic Supplier