Provider Demographics
NPI:1487969911
Name:TRENT, JUSTIN SHAY (DPT)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:SHAY
Last Name:TRENT
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 1:12728 STATE LINE ROAD
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209
Mailing Address - Country:US
Mailing Address - Phone:816-941-2550
Mailing Address - Fax:816-941-2520
Practice Address - Street 1:12728 STATE LINE ROAD
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66209
Practice Address - Country:US
Practice Address - Phone:816-941-2550
Practice Address - Fax:816-941-2520
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1104724225100000X
2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic