Provider Demographics
NPI:1962795260
Name:ANDERSON, TRUSTIN EDMONDS (DPT)
Entity type:Individual
Prefix:MR
First Name:TRUSTIN
Middle Name:EDMONDS
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2832 S MARYLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-1502
Mailing Address - Country:US
Mailing Address - Phone:702-735-5848
Mailing Address - Fax:702-735-1248
Practice Address - Street 1:2832 S MARYLAND PKWY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-1502
Practice Address - Country:US
Practice Address - Phone:702-735-5848
Practice Address - Fax:702-735-1248
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2450225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist