Provider Demographics
NPI:1093821217
Name:LEDAIN, TREVOR C (PT)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:C
Last Name:LEDAIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1188 106TH AVE NE STE 100
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-8612
Mailing Address - Country:US
Mailing Address - Phone:425-455-2630
Mailing Address - Fax:425-451-4390
Practice Address - Street 1:1188 106TH AVE NE STE 100
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-8612
Practice Address - Country:US
Practice Address - Phone:425-455-2630
Practice Address - Fax:425-451-4390
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010187225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist