Provider Demographics
NPI:1871949099
Name:TERRILL, TRENTON JOHN (PT DPT)
Entity type:Individual
Prefix:
First Name:TRENTON
Middle Name:JOHN
Last Name:TERRILL
Suffix:
Gender:M
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:3405 NW HUNTERS RIDGE TER
Practice Address - Street 2:STE 300
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66618-2509
Practice Address - Country:US
Practice Address - Phone:785-246-2300
Practice Address - Fax:785-246-2301
Is Sole Proprietor?:No
Enumeration Date:2016-05-06
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-05367225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist