Provider Demographics
NPI:1033435623
Name:ROEDERER, TRENT (PT)
Entity Type:Individual
Prefix:MR
First Name:TRENT
Middle Name:
Last Name:ROEDERER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 ROSEMAR RD
Mailing Address - Street 2:STE 1
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-7609
Mailing Address - Country:US
Mailing Address - Phone:304-295-3060
Mailing Address - Fax:304-295-3068
Practice Address - Street 1:155 E MAIN ST
Practice Address - Street 2:SUITE 148
Practice Address - City:MCCONNELSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43756-1296
Practice Address - Country:US
Practice Address - Phone:740-962-4441
Practice Address - Fax:740-962-4488
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH012758225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist