Provider Demographics
NPI:1992909956
Name:HUGHES, TROY MICHAL (PT)
Entity type:Individual
Prefix:MR
First Name:TROY
Middle Name:MICHAL
Last Name:HUGHES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 PALOMA AVE APT 104
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-2248
Mailing Address - Country:US
Mailing Address - Phone:650-339-3861
Mailing Address - Fax:
Practice Address - Street 1:77 PALOMA AVE APT 104
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-2248
Practice Address - Country:US
Practice Address - Phone:650-339-3861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2012-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32485225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA32485OtherPHYSICAL THERAPIST LIC#