Provider Demographics
NPI:1821234691
Name:ROY, KATHERINE M (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:ROY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 E 105TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64137-1569
Mailing Address - Country:US
Mailing Address - Phone:207-951-2131
Mailing Address - Fax:866-220-5031
Practice Address - Street 1:4500 E 105TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64137-1569
Practice Address - Country:US
Practice Address - Phone:207-951-2131
Practice Address - Fax:866-220-5031
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-29
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3442225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME9113270OtherAETNA
ME1821234691OtherANTHEM
MEP00677352OtherRR MEDICARE
ME1821234691OtherANTHEM