Provider Demographics
NPI:1700516440
Name:SCAVONE, ROY EDMOND MICHAEL (DPT)
Entity Type:Individual
Prefix:
First Name:ROY EDMOND
Middle Name:MICHAEL
Last Name:SCAVONE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:ROY
Other - Middle Name:
Other - Last Name:SCAVONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:10505 S INTERSTATE 35 APT 235
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78747-2609
Mailing Address - Country:US
Mailing Address - Phone:210-325-3337
Mailing Address - Fax:
Practice Address - Street 1:345 S WATER ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78401-2819
Practice Address - Country:US
Practice Address - Phone:361-500-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1361977225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist