Provider Demographics
NPI:1619446747
Name:ROYSE, TRENTON MICHAEL (LAT, ATC, CES)
Entity Type:Individual
Prefix:
First Name:TRENTON
Middle Name:MICHAEL
Last Name:ROYSE
Suffix:
Gender:M
Credentials:LAT, ATC, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7821 E 97TH PL APT 12306
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-6957
Mailing Address - Country:US
Mailing Address - Phone:402-417-3326
Mailing Address - Fax:
Practice Address - Street 1:7777 S LEWIS AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74171-0003
Practice Address - Country:US
Practice Address - Phone:918-495-7745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10102081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine