Provider Demographics
NPI:1134485790
Name:TRENTMAN, MICHELLE LYNN (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:LYNN
Last Name:TRENTMAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 WILLOW VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-3233
Mailing Address - Country:US
Mailing Address - Phone:314-775-7623
Mailing Address - Fax:
Practice Address - Street 1:3501 DUNN RD
Practice Address - Street 2:SUITE 108
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-6762
Practice Address - Country:US
Practice Address - Phone:314-839-0002
Practice Address - Fax:314-839-5994
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012011188225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2012011188Medicare PIN