Provider Demographics
NPI:1851459085
Name:THE TRAINING ROOM OF TRENTON LLC
Entity Type:Organization
Organization Name:THE TRAINING ROOM OF TRENTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLLE
Authorized Official - Middle Name:
Authorized Official - Last Name:OSTAFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-362-0081
Mailing Address - Street 1:3101 WEST RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2495
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3101 WEST RD
Practice Address - Street 2:SUITE 200
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-2495
Practice Address - Country:US
Practice Address - Phone:734-362-0081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N27080Medicare PIN