Provider Demographics
NPI:1467090266
Name:RAND, ROYALE (DPT)
Entity Type:Individual
Prefix:
First Name:ROYALE
Middle Name:
Last Name:RAND
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2737 77TH AVE SE STE 214
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-2832
Mailing Address - Country:US
Mailing Address - Phone:206-518-9405
Mailing Address - Fax:888-446-7044
Practice Address - Street 1:2737 77TH AVE SE STE 214
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2832
Practice Address - Country:US
Practice Address - Phone:206-518-9405
Practice Address - Fax:888-446-7044
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60970366225100000X
WA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60970366OtherLICENSE