Provider Demographics
NPI:1376877415
Name:ROYER, PAUL (RN LMT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:ROYER
Suffix:
Gender:M
Credentials:RN LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:15123 PORTAGE ST
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44230-1126
Mailing Address - Country:US
Mailing Address - Phone:330-608-0490
Mailing Address - Fax:330-658-6868
Practice Address - Street 1:1101 PORTAGE TRAIL EXT
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-8250
Practice Address - Country:US
Practice Address - Phone:330-608-0490
Practice Address - Fax:330-658-6868
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH178178163WM1400X
OH33007573225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist