Provider Demographics
NPI:1033291075
Name:PETTINGILL, TREVOR W (MPT)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:W
Last Name:PETTINGILL
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8501 171ST STREET CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-6181
Mailing Address - Country:US
Mailing Address - Phone:253-732-8116
Mailing Address - Fax:253-536-3467
Practice Address - Street 1:555 S BLUFF ST STE 102
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-7321
Practice Address - Country:US
Practice Address - Phone:435-215-1866
Practice Address - Fax:435-215-1844
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11729395-2401225100000X
WAPT00009504225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist