Provider Demographics
NPI:1346006533
Name:TROYA-SIXBURY, KIMBERLY RENEE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:RENEE
Last Name:TROYA-SIXBURY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4126 CHIWEENIE TRL
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:SC
Mailing Address - Zip Code:29853-5159
Mailing Address - Country:US
Mailing Address - Phone:727-744-4776
Mailing Address - Fax:
Practice Address - Street 1:219 SILVER BLUFF RD
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-7325
Practice Address - Country:US
Practice Address - Phone:727-744-4776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMAS11647225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist