Provider Demographics
NPI:1750344396
Name:PEPPERMAN, TROY WILLIAM (MS, ATC)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:WILLIAM
Last Name:PEPPERMAN
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 DRINKWATER RD
Mailing Address - Street 2:
Mailing Address - City:BAY ST LOUIS
Mailing Address - State:MS
Mailing Address - Zip Code:39520-1658
Mailing Address - Country:US
Mailing Address - Phone:228-467-8725
Mailing Address - Fax:228-467-8724
Practice Address - Street 1:149 DRINKWATER RD
Practice Address - Street 2:
Practice Address - City:BAY ST LOUIS
Practice Address - State:MS
Practice Address - Zip Code:39520-1658
Practice Address - Country:US
Practice Address - Phone:228-467-8725
Practice Address - Fax:228-467-8724
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSAT02412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS029902528OtherNATABOC
MSAT0241OtherSTATE LICENSE NUMBER-AT
MS962312OtherNATA