Provider Demographics
NPI:1144734500
Name:TRUNDLE, JOHN JACOB (LAT, ATC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JACOB
Last Name:TRUNDLE
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 CORBETT ST
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-8659
Mailing Address - Country:US
Mailing Address - Phone:919-943-0091
Mailing Address - Fax:
Practice Address - Street 1:2006 WORTHINGTON RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-8377
Practice Address - Country:US
Practice Address - Phone:252-756-3440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-30752255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer