Provider Demographics
NPI:1639630502
Name:TRENTLEY, CHASELYN MARIE (LAT, ATC)
Entity Type:Individual
Prefix:MISS
First Name:CHASELYN
Middle Name:MARIE
Last Name:TRENTLEY
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 MISTY MOUNTAIN RD APT 1619
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-5276
Mailing Address - Country:US
Mailing Address - Phone:703-304-6507
Mailing Address - Fax:
Practice Address - Street 1:20347 TIMBERLAKE RD STE B
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-7352
Practice Address - Country:US
Practice Address - Phone:434-845-9054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260033502255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0126003350OtherLICENSED ATHLETIC TRAINER (LAT)
1639630502OtherCERTIFIED ATHLETIC TRAINER (ATC)