Provider Demographics
NPI:1578132841
Name:ROYALL, BILLIE BULLARD
Entity Type:Individual
Prefix:
First Name:BILLIE
Middle Name:BULLARD
Last Name:ROYALL
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 1:1475 TRAPHILL UNION RD
Mailing Address - Street 2:
Mailing Address - City:TRAPHILL
Mailing Address - State:NC
Mailing Address - Zip Code:28685-9044
Mailing Address - Country:US
Mailing Address - Phone:336-984-6437
Mailing Address - Fax:
Practice Address - Street 1:1915 W PARK DR STE 102
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3777
Practice Address - Country:US
Practice Address - Phone:336-903-9293
Practice Address - Fax:336-903-9295
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-22
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BC3200X
NCA5607225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment