Provider Demographics
NPI:1154413276
Name:LING, TREVOR (DPT, ATC)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:
Last Name:LING
Suffix:
Gender:M
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 MALLORY LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-8233
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:
Practice Address - Street 1:5200 PARK AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3505
Practice Address - Country:US
Practice Address - Phone:901-683-9630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204477225100000X
PAPT018410225100000X
MD22079225100000X
TN7772225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3650036Medicaid
TN686107OtherUNITED HEALTHCARE GROUP PIN
TN7772OtherSTATE LICENSE
TN3080867OtherBCBS GROUP PIN
TN722076OtherUNITED HEALTHCARE PIN
TN01160826OtherAMERIGROUP PIN
TN4156211OtherBCBS PIN
TN3650036Medicare PIN