Provider Demographics
NPI:1891728762
Name:REID, TROY LYNN (PT)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:LYNN
Last Name:REID
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12072 W MCMILLAN RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-2462
Mailing Address - Country:US
Mailing Address - Phone:208-794-4283
Mailing Address - Fax:208-322-2825
Practice Address - Street 1:1525 S ORCHARD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-2620
Practice Address - Country:US
Practice Address - Phone:208-939-0533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-1641225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist