Provider Demographics
NPI:1508857947
Name:TRENT, TIMOTHY MARVIN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:MARVIN
Last Name:TRENT
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
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 CVPI
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641
Mailing Address - Country:US
Mailing Address - Phone:276-964-6771
Mailing Address - Fax:276-964-1208
Practice Address - Street 1:ONE CLINIC DR
Practice Address - Street 2:CLAYPOOL HILL
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-1100
Practice Address - Country:US
Practice Address - Phone:276-964-6771
Practice Address - Fax:276-964-1208
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305001480225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P96219Medicare UPIN
VA002542C55Medicare PIN