Provider Demographics
NPI:1598741845
Name:TROLLIET, DOMINIQUE ROBERT (MSPT)
Entity Type:Individual
Prefix:MR
First Name:DOMINIQUE
Middle Name:ROBERT
Last Name:TROLLIET
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 SIERRA RD
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-7156
Mailing Address - Country:US
Mailing Address - Phone:830-367-1251
Mailing Address - Fax:
Practice Address - Street 1:1740 JUNCTION HWY
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-9401
Practice Address - Country:US
Practice Address - Phone:830-257-3800
Practice Address - Fax:830-257-3802
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1164013225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist