Healthcare Provider Details

I. General information

NPI: 1184900094
Provider Name (Legal Business Name): TRENT JEFFREY CARTER ATC, LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2011
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 ROBERT DEDMAN DR MONCRIEF 1.218
AUSTIN TX
78712-1505
US

IV. Provider business mailing address

1501 LORRAINE LOOP
AUSTIN TX
78758-4933
US

V. Phone/Fax

Practice location:
  • Phone: 512-471-5513
  • Fax:
Mailing address:
  • Phone: 512-748-3741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT3835
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: