Basic Information
| Provider Information | |||||||||
| NPI: | 1508857947 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRENT | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | MARVIN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PHYSICAL THERAPIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX CVPI | ||||||||
| Address2: | |||||||||
| City: | RICHLANDS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2769646771 | ||||||||
| FaxNumber: | 2769641208 | ||||||||
| Practice Location | |||||||||
| Address1: | ONE CLINIC DR | ||||||||
| Address2: | CLAYPOOL HILL | ||||||||
| City: | RICHLANDS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 246411100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2769646771 | ||||||||
| FaxNumber: | 2769641208 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2005 | ||||||||
| LastUpdateDate: | 02/20/2008 | ||||||||
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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 | 2305001480 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.