Provider Demographics
NPI:1760608277
Name:ROYBAL, DEANNA L
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:L
Last Name:ROYBAL
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 1:615 E LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-4502
Mailing Address - Country:US
Mailing Address - Phone:505-426-8095
Mailing Address - Fax:505-426-8095
Practice Address - Street 1:615 E LINCOLN ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4502
Practice Address - Country:US
Practice Address - Phone:505-426-8095
Practice Address - Fax:505-426-8095
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-0389225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant