Provider Demographics
NPI:1023286119
Name:CYPRESS BROADNAX, TROY BRIONE (LMT)
Entity type:Individual
Prefix:MR
First Name:TROY
Middle Name:BRIONE
Last Name:CYPRESS BROADNAX
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 W 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3868
Mailing Address - Country:US
Mailing Address - Phone:541-484-3632
Mailing Address - Fax:
Practice Address - Street 1:915 OAK ST STE 315
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3142
Practice Address - Country:US
Practice Address - Phone:541-913-6553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14007225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist