Provider Demographics
NPI:1619975968
Name:TROYER, JUDY LYNN (MPT)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:LYNN
Last Name:TROYER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24944 COVENTRY DR
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-7694
Mailing Address - Country:US
Mailing Address - Phone:208-453-3261
Mailing Address - Fax:
Practice Address - Street 1:680 S PROGRESS AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2957
Practice Address - Country:US
Practice Address - Phone:208-888-3669
Practice Address - Fax:208-888-3675
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-1737225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist