Provider Demographics
NPI:1831174812
Name:CRIBBINS, TROY ALAN (PT)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:ALAN
Last Name:CRIBBINS
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 1:410 DATE AVENUE
Mailing Address - Street 2:ACCESS REHABILITATION
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420
Mailing Address - Country:US
Mailing Address - Phone:541-217-5229
Mailing Address - Fax:
Practice Address - Street 1:410 DATE AVENUE
Practice Address - Street 2:ACCESS REHABILITATION
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420
Practice Address - Country:US
Practice Address - Phone:541-217-5229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5073225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR161133OtherNBMC GROUP MEDICAID
ORR0000WFBTVOtherNBMC GROUP MEDICARE
OR930635514OtherNBMC GROUP TAX ID OR BILLING
OR1407812365OtherNBMC GROUP MAIN NPI
OR1900 WOODLAND DROtherNBMC GROUP PRACTICE ADDRESS - COOS BAY