Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 06004259A | IN |
NPI | 1013295393 |
---|---|
Provider Name | Charles E Royston III |
First Address | Carmel, IN 46032-2923 |
Second Address | Carmel, IN 46032-2923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2011 |
Last Update Date | 03/08/2011 |