Provider Demographics
NPI:1689158107
Name:MASSIE, TROY A
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:A
Last Name:MASSIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 10TH ST
Mailing Address - Street 2:
Mailing Address - City:FLORESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78114-2770
Mailing Address - Country:US
Mailing Address - Phone:830-393-8800
Mailing Address - Fax:830-393-8828
Practice Address - Street 1:2004 10TH ST
Practice Address - Street 2:
Practice Address - City:FLORESVILLE
Practice Address - State:TX
Practice Address - Zip Code:78114-2770
Practice Address - Country:US
Practice Address - Phone:830-393-8800
Practice Address - Fax:830-393-8828
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1310319225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1310319OtherPT LICENSE