Provider Demographics
NPI:1013459189
Name:TRINITY PHYSICAL THERAPY
Entity Type:Organization
Organization Name:TRINITY PHYSICAL THERAPY
Other - Org Name:ASCENT PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BART
Authorized Official - Middle Name:LANDON
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, CEAS
Authorized Official - Phone:812-346-5900
Mailing Address - Street 1:1111 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47265-7476
Mailing Address - Country:US
Mailing Address - Phone:812-346-5900
Mailing Address - Fax:866-896-3952
Practice Address - Street 1:1111 N STATE ST
Practice Address - Street 2:
Practice Address - City:NORTH VERNON
Practice Address - State:IN
Practice Address - Zip Code:47265-7476
Practice Address - Country:US
Practice Address - Phone:812-346-5900
Practice Address - Fax:866-896-3952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05009806A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty