Provider Demographics
NPI:1619220654
Name:TROMBLEY, TREVOR GREGORY (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:GREGORY
Last Name:TROMBLEY
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WHITNEY ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:13668-1407
Mailing Address - Country:US
Mailing Address - Phone:315-447-5934
Mailing Address - Fax:
Practice Address - Street 1:1282 MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VT
Practice Address - Zip Code:05454-9534
Practice Address - Country:US
Practice Address - Phone:802-849-9308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033588-1225100000X
VT040.0090673225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist