Healthcare Provider Details

I. General information

NPI: 1033029129
Provider Name (Legal Business Name): LILLIAN TROY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

643 HIGHWAY 14 STE 108
OKA GU
96913
US

IV. Provider business mailing address

112 GARDENIA ST
DEDEDO GU
96929-7002
US

V. Phone/Fax

Practice location:
  • Phone: 671-735-8000
  • Fax:
Mailing address:
  • Phone: 671-735-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPT-2026-02
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: