Provider Demographics
NPI:1487257960
Name:ROYCE, FELICIA (LMT)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:ROYCE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1693 SW 20TH CT
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-9655
Mailing Address - Country:US
Mailing Address - Phone:503-740-5009
Mailing Address - Fax:
Practice Address - Street 1:3314 S KELLY AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4628
Practice Address - Country:US
Practice Address - Phone:503-740-5009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1487811840OtherRIVER WEST ACUPUNCTURE