Provider Demographics
NPI:1770892366
Name:HENDERSON, TRENT C (PT)
Entity type:Individual
Prefix:MR
First Name:TRENT
Middle Name:C
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 N 300 W STE 103
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-1815
Mailing Address - Country:US
Mailing Address - Phone:801-546-6868
Mailing Address - Fax:801-546-8225
Practice Address - Street 1:335 N 300 W STE 103
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-1815
Practice Address - Country:US
Practice Address - Phone:801-546-6868
Practice Address - Fax:801-546-8225
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7759519-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist