MEDICARE: TRENT MCMULLEN DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PTH11637	AL

General Provider Information

NPI Number	:	1336918655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRENT MCMULLEN DPT

Provider Business Mailing Address
First Line	:	2823 GREYSTONE COMMERCIAL BLVD
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35242-2660
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4774 EASTERN VALLEY RD STE 109
Second Line	:
City	:	MC CALLA
State	:	AL
Zip	:	35111-3565
Country	:	US
Telephone Number	:	205-477-1501
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2023
Last Update Date	:	12/28/2023

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