Provider Demographics
NPI:1245422146
Name:TRENT, EDWARD LEE (PT)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:LEE
Last Name:TRENT
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:PO BOX 1810
Mailing Address - Street 2:
Mailing Address - City:CLINTWOOD
Mailing Address - State:VA
Mailing Address - Zip Code:24228-1810
Mailing Address - Country:US
Mailing Address - Phone:276-926-4516
Mailing Address - Fax:276-926-6652
Practice Address - Street 1:4862 DICKENSON HIGHWAY
Practice Address - Street 2:
Practice Address - City:CLINTWOOD
Practice Address - State:VA
Practice Address - Zip Code:24228
Practice Address - Country:US
Practice Address - Phone:276-926-4516
Practice Address - Fax:276-926-6652
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205162225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA196257OtherANTHEM
VA7815948OtherAETNA
VA496705Medicare PIN