Provider Demographics
NPI:1417647702
Name:TROYER, MIA
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:TROYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 S MILLEDGE AVE UNIT 5
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-1821
Mailing Address - Country:US
Mailing Address - Phone:214-693-1154
Mailing Address - Fax:
Practice Address - Street 1:2005 S MILLEDGE AVE UNIT 5
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-1821
Practice Address - Country:US
Practice Address - Phone:214-693-1154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0000394942092255A2300X, 390200000X
2255A2300X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer