Healthcare Provider Details

I. General information

NPI: 1992909956
Provider Name (Legal Business Name): TROY MICHAL HUGHES P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 12/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 PALOMA AVE APT 104
PACIFICA CA
94044-2248
US

IV. Provider business mailing address

77 PALOMA AVE APT 104
PACIFICA CA
94044-2248
US

V. Phone/Fax

Practice location:
  • Phone: 650-339-3861
  • Fax:
Mailing address:
  • Phone: 650-339-3861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number32485
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: