Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter | C50152 | WV |
Y | 225700000X | Massage Therapist | 2005-1782 | WV |
NPI | 1235415910 |
---|---|
Provider Name | Clifton Nathaniel Royse |
First Address | Morgantown, WV 26505-2812 |
Second Address | Morgantown, WV 26505-2812 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2011 |
Last Update Date | 25/10/2013 |