Provider Demographics
NPI:1073229415
Name:HARTSHORN, TRENT
Entity Type:Individual
Prefix:
First Name:TRENT
Middle Name:
Last Name:HARTSHORN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 ROCKHAVEN RD SE
Mailing Address - Street 2:
Mailing Address - City:NASHPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43830-9606
Mailing Address - Country:US
Mailing Address - Phone:740-973-3092
Mailing Address - Fax:
Practice Address - Street 1:35 S PARK PL
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-5559
Practice Address - Country:US
Practice Address - Phone:740-973-3092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH07884225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant