Basic Information
| Provider Information | |||||||||
| NPI: | 1033435623 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROEDERER | ||||||||
| FirstName: | TRENT | ||||||||
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| NamePrefix: | MR. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 133 ROSEMAR RD | ||||||||
| Address2: | STE 1 | ||||||||
| City: | PARKERSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 261047609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042953060 | ||||||||
| FaxNumber: | 3042953068 | ||||||||
| Practice Location | |||||||||
| Address1: | 155 E MAIN ST | ||||||||
| Address2: | SUITE 148 | ||||||||
| City: | MCCONNELSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437561296 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7409624441 | ||||||||
| FaxNumber: | 7409624488 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2010 | ||||||||
| LastUpdateDate: | 09/08/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 012758 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.