Provider Demographics
NPI:1396101572
Name:LAIRD, TRENTON (PT, ATC)
Entity type:Individual
Prefix:DR
First Name:TRENTON
Middle Name:
Last Name:LAIRD
Suffix:
Gender:M
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 E RIVERSIDE DR STE 303
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-8722
Mailing Address - Country:US
Mailing Address - Phone:435-673-4303
Mailing Address - Fax:435-673-4003
Practice Address - Street 1:617 E RIVERSIDE DR STE 303
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-8722
Practice Address - Country:US
Practice Address - Phone:435-673-4303
Practice Address - Fax:435-673-4003
Is Sole Proprietor?:No
Enumeration Date:2016-01-04
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10742164-2401225100000X
NV3261225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV112837Medicare PIN