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General NPI Number Information
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NPI Number | 1336752484
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Entity Type | Individual
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Provider Name | TRENT SEBASTIAN VANDEVORT PT, DPT, LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 08/28/2020
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Last Update Date | 03/06/2024
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Provider Practice Location Address
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Address Line | 3200 S WATER ST
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City | PITTSBURGH
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State | PA
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Zip | 15203-2307
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Country | US
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Telephone | 844-977-2027
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Fax |
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Provider Business Mailing Address
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Address Line | 239 LA RAY DR
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City | BUTLER
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State | PA
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Zip | 16001-1425
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Country | US
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Telephone | 724-496-7719
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | RT008130
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT032085
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License Number State | PA
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