Healthcare Provider Details

I. General information

NPI: 1699615096
Provider Name (Legal Business Name): TROY FLATHAU LMT, CMMP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 MILITARY ST
PORT HURON MI
48060-5418
US

IV. Provider business mailing address

3623 CHARLES ST
BURTCHVILLE MI
48059-2206
US

V. Phone/Fax

Practice location:
  • Phone: 615-500-7099
  • Fax:
Mailing address:
  • Phone: 615-500-7099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501011358
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: