Provider Demographics
NPI:1689282899
Name:TROTTER LIND, MISHA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MISHA
Middle Name:
Last Name:TROTTER LIND
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 KOLL CENTER PKWY STE 320
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-7032
Mailing Address - Country:US
Mailing Address - Phone:925-730-0950
Mailing Address - Fax:
Practice Address - Street 1:6700 KOLL CENTER PKWY STE 320
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-7032
Practice Address - Country:US
Practice Address - Phone:925-730-0950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTP-PTA-LIC-7628225200000X
CA298539225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant