Provider Demographics
NPI:1316078322
Name:TROXELL, HENRY WAYNE (DPT, OCS)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:WAYNE
Last Name:TROXELL
Suffix:
Gender:M
Credentials:DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 HOWARD RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-5163
Mailing Address - Country:US
Mailing Address - Phone:559-661-1611
Mailing Address - Fax:559-661-1612
Practice Address - Street 1:2351 W CLEVELAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-8767
Practice Address - Country:US
Practice Address - Phone:559-661-1611
Practice Address - Fax:559-661-1612
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT20536174400000X
2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT205361Medicare ID - Type Unspecified