Provider Demographics
NPI:1194812800
Name:TRENTADUE, BARBARA LEE (LPTA)
Entity type:Individual
Prefix:MISS
First Name:BARBARA
Middle Name:LEE
Last Name:TRENTADUE
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 SW 107TH AVE APT 3501
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-3167
Mailing Address - Country:US
Mailing Address - Phone:503-380-9520
Mailing Address - Fax:
Practice Address - Street 1:3710 SW US VETERANS HOSPITAL ROAD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97207-1034
Practice Address - Country:US
Practice Address - Phone:503-280-8262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7140225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant