Provider Demographics
NPI:1871831347
Name:ROYAL, VICTORIA WOODS (PTA)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:WOODS
Last Name:ROYAL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 MOURNING DOVE TER
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27409-9130
Mailing Address - Country:US
Mailing Address - Phone:336-259-4239
Mailing Address - Fax:
Practice Address - Street 1:325 MOURNING DOVE TER
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27409-9130
Practice Address - Country:US
Practice Address - Phone:336-259-4239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA4998225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant