Provider Demographics
NPI:1558813550
Name:LAMBETH, TRINITY
Entity Type:Individual
Prefix:
First Name:TRINITY
Middle Name:
Last Name:LAMBETH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5453 OLD SHELL RD
Mailing Address - Street 2:APT 131
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-3072
Mailing Address - Country:US
Mailing Address - Phone:850-207-1341
Mailing Address - Fax:251-445-9568
Practice Address - Street 1:5453 OLD SHELL RD
Practice Address - Street 2:APT 131
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3072
Practice Address - Country:US
Practice Address - Phone:850-207-1341
Practice Address - Fax:251-445-9568
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17152255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer