MEDICARE: TRENT JONATHAN FORSHEY

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	P18086	NC

General Provider Information

NPI Number	:	1457875767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRENT JONATHAN FORSHEY

Provider Business Mailing Address
First Line	:	350 NEW FIDELITY CT
Second Line	:
City	:	GARNER
State	:	NC
Zip	:	27529-2665
Country	:	US
Telephone Number	:	919-258-2714
Fax Number	:	410-648-4878

Provider Business Practice Location Address
First Line	:	2126 WAYNE MEMORIAL DR
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27534
Country	:	US
Telephone Number	:	919-766-9022
Fax Number	:	919-709-0433

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

Provider Enumeration Date	:	07/28/2017
Last Update Date	:	07/27/2018

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Directions to “ TRENT JONATHAN FORSHEY ” Practice Location

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