Provider Demographics
NPI:1932958923
Name:MIDDLETON, TRENTON ANTHONY (PTA)
Entity type:Individual
Prefix:
First Name:TRENTON
Middle Name:ANTHONY
Last Name:MIDDLETON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14909 VIEWCREST RD SW
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-5828
Mailing Address - Country:US
Mailing Address - Phone:301-697-8061
Mailing Address - Fax:
Practice Address - Street 1:14909 VIEWCREST RD SW
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-5828
Practice Address - Country:US
Practice Address - Phone:301-697-8061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV002853225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant