Healthcare Provider Details

I. General information

NPI: 1801713300
Provider Name (Legal Business Name): TRENT R BRASS RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2026
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204 HARLEM BLVD
ROCKFORD IL
61103-4817
US

IV. Provider business mailing address

2204 HARLEM BLVD
ROCKFORD IL
61103-4817
US

V. Phone/Fax

Practice location:
  • Phone: 815-218-2407
  • Fax:
Mailing address:
  • Phone: 815-218-2407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number194008267
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: