Provider Demographics
NPI:1265588388
Name:SCHIELD, ROYCE DEAN
Entity type:Individual
Prefix:
First Name:ROYCE
Middle Name:DEAN
Last Name:SCHIELD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1646 S GLENDALE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-4320
Mailing Address - Country:US
Mailing Address - Phone:316-682-5895
Mailing Address - Fax:
Practice Address - Street 1:625 N CARRIAGE PKWY
Practice Address - Street 2:ST. 110
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-4510
Practice Address - Country:US
Practice Address - Phone:316-684-8735
Practice Address - Fax:316-683-2128
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-00317225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist