Healthcare Provider Details

I. General information

NPI: 1083262760
Provider Name (Legal Business Name): TREVOR DENTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 W MAIN ST STE 120
NORTHVILLE MI
48167-1548
US

IV. Provider business mailing address

5656 W US HIGHWAY 10
LUDINGTON MI
49431-2454
US

V. Phone/Fax

Practice location:
  • Phone: 248-347-1168
  • Fax:
Mailing address:
  • Phone: 231-672-6977
  • Fax: 231-316-1084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: