Healthcare Provider Details

I. General information

NPI: 1063329381
Provider Name (Legal Business Name): TREVOR MICHAEL JARSOMBECK DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22454 US HIGHWAY 72 STE 300
ATHENS AL
35613-2678
US

IV. Provider business mailing address

927 FRANKLIN ST SE
HUNTSVILLE AL
35801-4306
US

V. Phone/Fax

Practice location:
  • Phone: 256-233-2332
  • Fax:
Mailing address:
  • Phone: 312-459-4699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH12804
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: