Provider Demographics
NPI:1083624159
Name:TROST, GEORGE EHREN (MPT)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:EHREN
Last Name:TROST
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 ANDERSON DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-3206
Mailing Address - Country:US
Mailing Address - Phone:814-450-5463
Mailing Address - Fax:814-860-3128
Practice Address - Street 1:3425 PEACH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2779
Practice Address - Country:US
Practice Address - Phone:814-450-5463
Practice Address - Fax:814-860-3128
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT010963-L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000579275OtherHIGHMARK
PAS71945Medicare UPIN
PA023576Medicare ID - Type UnspecifiedMEDICARE