Provider Demographics
NPI:1962485300
Name:TRUNDLE, TERRY (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:TRUNDLE
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2529 EDEN RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-3026
Mailing Address - Country:US
Mailing Address - Phone:770-792-7522
Mailing Address - Fax:770-792-7508
Practice Address - Street 1:880 CANTON RD NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7276
Practice Address - Country:US
Practice Address - Phone:770-792-7522
Practice Address - Fax:770-792-7508
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0002932255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer