Provider Demographics
NPI:1083789598
Name:LINDSTROM, TROY A (DPT, ATC)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:A
Last Name:LINDSTROM
Suffix:
Gender:M
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4411 POINT FOSDICK DR NW STE 101
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1703
Mailing Address - Country:US
Mailing Address - Phone:253-552-2525
Mailing Address - Fax:253-552-2526
Practice Address - Street 1:1550 S UNION AVE STE 130
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1946
Practice Address - Country:US
Practice Address - Phone:253-552-2525
Practice Address - Fax:253-552-2526
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008899225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7573LIOtherREGENCE BCBS
WA8336471Medicaid
WA171465OtherLABOR AND INDUSTRIES WC
WA8336471Medicaid