Provider Demographics
NPI:1033263843
Name:STONE, TRENT DOUGLAS (PT, DPT, MS, ATC)
Entity Type:Individual
Prefix:
First Name:TRENT
Middle Name:DOUGLAS
Last Name:STONE
Suffix:
Gender:M
Credentials:PT, DPT, MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4425 PAULSEN STREET
Mailing Address - Street 2:BLDG A
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405
Mailing Address - Country:US
Mailing Address - Phone:912-525-1281
Mailing Address - Fax:912-354-5970
Practice Address - Street 1:4425 PAULSEN STREET
Practice Address - Street 2:BLDG A
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405
Practice Address - Country:US
Practice Address - Phone:912-525-1281
Practice Address - Fax:912-354-5970
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD22123225100000X
GA009368225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD468MS358Medicare Oscar/Certification