Provider Demographics
NPI:1528379260
Name:MAYLE, ROGER ALAN (LPTA)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:ALAN
Last Name:MAYLE
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 E MILL ST
Mailing Address - Street 2:
Mailing Address - City:HUMANSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65674
Mailing Address - Country:US
Mailing Address - Phone:417-754-1601
Mailing Address - Fax:417-754-1602
Practice Address - Street 1:202 E MILL ST
Practice Address - Street 2:
Practice Address - City:HUMANSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65674-8507
Practice Address - Country:US
Practice Address - Phone:417-754-1601
Practice Address - Fax:417-754-1602
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO115385225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant