Provider Demographics
NPI:1588852875
Name:TROST, CAROL (LMP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:TROST
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 112
Mailing Address - Street 2:
Mailing Address - City:MEAD
Mailing Address - State:WA
Mailing Address - Zip Code:99021-0112
Mailing Address - Country:US
Mailing Address - Phone:509-879-1941
Mailing Address - Fax:
Practice Address - Street 1:111 E LINCOLN RD STE 1
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-6901
Practice Address - Country:US
Practice Address - Phone:509-879-1941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016437225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0169255OtherLNI
1588852875OtherMASSAGE THERAPY