Healthcare Provider Details

I. General information

NPI: 1386360394
Provider Name (Legal Business Name): TERRY BRADLEY TRENT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 03/15/2026
Certification Date: 03/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WILLIAM CARLS DR
COMMERCE TOWNSHIP MI
48382-2201
US

IV. Provider business mailing address

1 WILLIAM CARLS DR
COMMERCE TOWNSHIP MI
48382-2201
US

V. Phone/Fax

Practice location:
  • Phone: 839-255-7120
  • Fax: 704-519-2840
Mailing address:
  • Phone: 839-255-7120
  • Fax: 704-519-2840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: