1326457250 NPI number — DENEE ROCHELLE TROSTERUD PT, DPT

Table of content: DENEE ROCHELLE TROSTERUD PT, DPT (NPI 1326457250)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326457250 NPI number — DENEE ROCHELLE TROSTERUD PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TROSTERUD
Provider First Name:
DENEE
Provider Middle Name:
ROCHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STENTZ
Provider Other First Name:
DENEE
Provider Other Middle Name:
ROCHELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT, DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1326457250
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8823 PRODUCTION LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OOLTEWAH
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37363-6511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-238-7217
Provider Business Mailing Address Fax Number:
423-362-8684

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3645 MARKETPLACE BLVD
Provider Second Line Business Practice Location Address:
STE 160
Provider Business Practice Location Address City Name:
EAST POINT
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30344-5747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-344-2823
Provider Business Practice Location Address Fax Number:
404-629-3737
Provider Enumeration Date:
08/05/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT011614 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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