Provider Demographics
NPI:1629408851
Name:ROYCE, REBECCA (DPT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:ROYCE
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 1:555 SE LAUREL ST
Mailing Address - Street 2:UNIT 13
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-8165
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4725 MERLE HAY RD
Practice Address - Street 2:SUITE 107
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50322-1983
Practice Address - Country:US
Practice Address - Phone:515-331-3190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-25
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004777225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist