Basic Information
| Provider Information | |||||||||
| NPI: | 1790395994 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TROK | ||||||||
| FirstName: | NATHANIEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 CORPORATE DR STE 400 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352425424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232388923 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2946 WINFIELD DUNN PKWY STE 106 | ||||||||
| Address2: | |||||||||
| City: | KODAK | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377644318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8659321088 | ||||||||
| FaxNumber: | 8659321454 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2020 | ||||||||
| LastUpdateDate: | 08/03/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.