Provider Demographics
NPI:1891742961
Name:ROYTER, JEFF ROYCE (PT)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:ROYCE
Last Name:ROYTER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3115
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-3115
Mailing Address - Country:US
Mailing Address - Phone:208-772-8147
Mailing Address - Fax:
Practice Address - Street 1:1512 N VERCLER RD
Practice Address - Street 2:SUITE 1
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1087
Practice Address - Country:US
Practice Address - Phone:509-891-0658
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT 750225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist