Provider Demographics
NPI:1720619315
Name:TRENCHUK, DWAYNE ALVIN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:DWAYNE
Middle Name:ALVIN
Last Name:TRENCHUK
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
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Mailing Address - Street 1:2 ROQUEDO
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-2721
Mailing Address - Country:US
Mailing Address - Phone:714-925-9661
Mailing Address - Fax:
Practice Address - Street 1:2 ROQUEDO
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-2721
Practice Address - Country:US
Practice Address - Phone:714-925-9661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-01
Last Update Date:2020-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT89962251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics