Provider Demographics
NPI:1962672816
Name:MCGARY, TRENT ROBERT (DPT)
Entity Type:Individual
Prefix:
First Name:TRENT
Middle Name:ROBERT
Last Name:MCGARY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3854 E 300 N
Mailing Address - Street 2:BOX 12
Mailing Address - City:RIGBY
Mailing Address - State:ID
Mailing Address - Zip Code:83442-5422
Mailing Address - Country:US
Mailing Address - Phone:208-709-2645
Mailing Address - Fax:208-524-1701
Practice Address - Street 1:3854 E 300 N
Practice Address - Street 2:BOX 12
Practice Address - City:RIGBY
Practice Address - State:ID
Practice Address - Zip Code:83442-5422
Practice Address - Country:US
Practice Address - Phone:208-709-2645
Practice Address - Fax:208-524-1701
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-06
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-2225225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist