Provider Demographics
NPI:1134628134
Name:CONANT, TREVOR ROBERT (PT, DPT)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:ROBERT
Last Name:CONANT
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 PAMELA LN
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-9446
Mailing Address - Country:US
Mailing Address - Phone:979-587-1189
Mailing Address - Fax:
Practice Address - Street 1:7616 LBJ FWY STE 640
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-1184
Practice Address - Country:US
Practice Address - Phone:214-960-4038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
13011390225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist