Provider Demographics
NPI:1669621959
Name:ROYCE, MARISSA DAWN (PTA)
Entity type:Individual
Prefix:MS
First Name:MARISSA
Middle Name:DAWN
Last Name:ROYCE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:MARISSA
Other - Middle Name:DAWN
Other - Last Name:SCHMIDT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:29 MADISON PLACE
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:NH
Mailing Address - Zip Code:03743
Mailing Address - Country:US
Mailing Address - Phone:603-542-4750
Mailing Address - Fax:
Practice Address - Street 1:29 MADISON PL
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:NH
Practice Address - Zip Code:03743-4112
Practice Address - Country:US
Practice Address - Phone:603-542-4750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0362225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant