Provider Demographics
NPI:1184900094
Name:CARTER, TRENT JEFFREY (ATC, LAT)
Entity type:Individual
Prefix:
First Name:TRENT
Middle Name:JEFFREY
Last Name:CARTER
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 1:1501 LORRAINE LOOP
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-4933
Mailing Address - Country:US
Mailing Address - Phone:512-748-3741
Mailing Address - Fax:
Practice Address - Street 1:2012 ROBERT DEDMAN DR
Practice Address - Street 2:MONCRIEF 1.218
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712-1505
Practice Address - Country:US
Practice Address - Phone:512-471-5513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT38352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer