Provider Demographics
NPI:1609101492
Name:TRIMBO, ROBERT LOUIS (DPT)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LOUIS
Last Name:TRIMBO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:DR
Other - First Name:ROBBY
Other - Middle Name:LOUIS
Other - Last Name:TRIMBO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:109 S 65TH AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-3408
Mailing Address - Country:US
Mailing Address - Phone:360-309-6189
Mailing Address - Fax:360-309-6193
Practice Address - Street 1:109 S 65TH AVE
Practice Address - Street 2:STE 105
Practice Address - City:RIDGEFIELD
Practice Address - State:WA
Practice Address - Zip Code:98642-3408
Practice Address - Country:US
Practice Address - Phone:360-309-6189
Practice Address - Fax:360-309-6193
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-12
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT601021782251S0007X, 2251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPT60102178OtherPT LICENSE
WA8886376Medicare PIN