Provider Demographics
NPI:1548535115
Name:ROYALL, JIMMY RAY (CFTS)
Entity type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:RAY
Last Name:ROYALL
Suffix:
Gender:M
Credentials:CFTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1138
Mailing Address - Street 2:
Mailing Address - City:YADKINVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27055-1138
Mailing Address - Country:US
Mailing Address - Phone:336-776-1599
Mailing Address - Fax:336-661-9378
Practice Address - Street 1:2491 ARMSTRONG DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6813
Practice Address - Country:US
Practice Address - Phone:336-776-1599
Practice Address - Fax:336-661-9378
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other