Provider Demographics
NPI:1982490678
Name:PRICE, TRENT R (LMT)
Entity type:Individual
Prefix:
First Name:TRENT
Middle Name:R
Last Name:PRICE
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 SW SPRING GARDEN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-3966
Mailing Address - Country:US
Mailing Address - Phone:503-841-6222
Mailing Address - Fax:
Practice Address - Street 1:2505 SW SPRING GARDEN ST STE 100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-3966
Practice Address - Country:US
Practice Address - Phone:503-841-6222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR28895225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist