Provider Demographics
NPI:1447016233
Name:ARCHER, TRENT
Entity type:Individual
Prefix:
First Name:TRENT
Middle Name:
Last Name:ARCHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 N ARIZONA AVE UNIT 1217
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-0710
Mailing Address - Country:US
Mailing Address - Phone:602-750-7280
Mailing Address - Fax:
Practice Address - Street 1:1255 N ARIZONA AVE UNIT 1217
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-0710
Practice Address - Country:US
Practice Address - Phone:602-750-7280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPTA-013945225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant