Provider Demographics
NPI:1669794855
Name:TRENT, ELIZABETH BARBOSA (LMT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BARBOSA
Last Name:TRENT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:BARBOSA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:422 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1847
Mailing Address - Country:US
Mailing Address - Phone:304-848-6684
Mailing Address - Fax:
Practice Address - Street 1:422 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1847
Practice Address - Country:US
Practice Address - Phone:304-848-6684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVF2003-1354173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist