Provider Demographics
NPI:1902404700
Name:ROYAL, TALIAH (DPT)
Entity Type:Individual
Prefix:
First Name:TALIAH
Middle Name:
Last Name:ROYAL
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 1:1403 MISTY GLEN LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75232-1533
Mailing Address - Country:US
Mailing Address - Phone:214-403-2389
Mailing Address - Fax:
Practice Address - Street 1:2758 N GALLOWAY AVE STE 100
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6381
Practice Address - Country:US
Practice Address - Phone:972-681-1155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1338379225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist