Healthcare Provider Details

I. General information

NPI: 1033435623
Provider Name (Legal Business Name): TRENT ROEDERER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 S 2ND ST
BYESVILLE OH
43723-1303
US

IV. Provider business mailing address

171 S 2ND ST
BYESVILLE OH
43723-1303
US

V. Phone/Fax

Practice location:
  • Phone: 740-685-9800
  • Fax: 740-470-1152
Mailing address:
  • Phone: 740-685-9800
  • Fax: 740-470-1152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT012758
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: