Provider Demographics
NPI:1154898385
Name:KERSHNER, TRENTON (LMT)
Entity type:Individual
Prefix:
First Name:TRENTON
Middle Name:
Last Name:KERSHNER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61055 BORDEN DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3021
Mailing Address - Country:US
Mailing Address - Phone:541-788-8927
Mailing Address - Fax:
Practice Address - Street 1:155 SW CENTURY DR STE 110
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1657
Practice Address - Country:US
Practice Address - Phone:541-788-8927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24076225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR46-3031408OtherRECHARGE