Provider Demographics
NPI:1407043359
Name:ROYAL, BARBARA DIANE (PTA)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:DIANE
Last Name:ROYAL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7591 EASTERLY LN
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-4316
Mailing Address - Country:US
Mailing Address - Phone:901-759-1440
Mailing Address - Fax:
Practice Address - Street 1:5070 SANDERLIN AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4332
Practice Address - Country:US
Practice Address - Phone:901-683-5677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN368225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant