Provider Demographics
NPI:1548305436
Name:ROY, SCOTT JERRY (ATC)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:JERRY
Last Name:ROY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:95 BURPEE HILL RD
Mailing Address - Street 2:
Mailing Address - City:GRANTHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03753-3601
Mailing Address - Country:US
Mailing Address - Phone:603-863-3255
Mailing Address - Fax:603-863-3255
Practice Address - Street 1:6083 ALUMNI GYM, WHEELOCK ST
Practice Address - Street 2:DARTMOUTH COLLEGE
Practice Address - City:HANOVER
Practice Address - State:NH
Practice Address - Zip Code:03755
Practice Address - Country:US
Practice Address - Phone:603-646-2472
Practice Address - Fax:603-646-6455
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH00482255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer