Healthcare Provider Details

I. General information

NPI: 1770083925
Provider Name (Legal Business Name): TROY DANIEL BURRELL BS,CBIS,ATRI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2018
Last Update Date: 02/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 WEST BIG BEAVER RD SUITE 228
TROY MI
48084
US

IV. Provider business mailing address

3250 WEST BIG BEAVER RD SUITE 228
TROY MI
48084
US

V. Phone/Fax

Practice location:
  • Phone: 248-792-3633
  • Fax:
Mailing address:
  • Phone: 248-792-3633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: