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Individual
TROY MICHAEL MCDONOUGH
Active
Individual
TROY MICHAEL MCDONOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S.P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
005262
IA
2251X0800X
Orthopedic Physical Therapist
1768PT
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000344097
—
MT
01
—
000060776
BLUE CROSS FOR SEELY LAKE
MT
01
—
00006175
BLUE CROSS
MT
Enumeration date
06/26/2007
Last updated
08/05/2015
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