Healthcare Provider Details

I. General information

NPI: 1831083880
Provider Name (Legal Business Name): TRENT ALLEN SUCKUT MAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W UNIVERSITY AVE
MITCHELL SD
57301-4398
US

IV. Provider business mailing address

609 E 3RD AVE
MITCHELL SD
57301-3523
US

V. Phone/Fax

Practice location:
  • Phone: 800-333-8506
  • Fax:
Mailing address:
  • Phone: 206-743-1636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: