Provider Demographics
NPI:1437687969
Name:TRINCHERA, VICTOR (PTA)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:TRINCHERA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 MILLSTONE CIR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:TN
Mailing Address - Zip Code:37716-7222
Mailing Address - Country:US
Mailing Address - Phone:865-776-2215
Mailing Address - Fax:
Practice Address - Street 1:501 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-4336
Practice Address - Country:US
Practice Address - Phone:601-684-8111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-29
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5828225200000X
TN5825225200000X
MSCP001159A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant