Provider Demographics
NPI:1881954667
Name:TROST, GUSTAV (PT)
Entity type:Individual
Prefix:MR
First Name:GUSTAV
Middle Name:
Last Name:TROST
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 1:5380 SADDLE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-6643
Mailing Address - Country:US
Mailing Address - Phone:208-866-3689
Mailing Address - Fax:
Practice Address - Street 1:5380 SADDLE ROCK RD
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-6643
Practice Address - Country:US
Practice Address - Phone:208-866-3689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTP-PT-LIC-1848225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist