| Doctor Name: | MR. TRENT JACKMAN |
| NPI Number: | 1053503193 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT |
| License Number: | PT-1236 |
| Business Practice Address: | Garrison Bldg 63, Room 202 Stop 8045 Pocatello, ID - 832090001 |
| Business Phone Number: | 2082823065 |
| Business Fax Number: | |
| Mailing Address: | Dept Of Physical Therapy Idaho State University, Stop 8045 POCATELLO |
| State: | ID |
| Postal Code: | 832090001 |
| Phone Number: | 2082823065 |
| Fax Number: | |
| NPI Enumeration Date: | 08/13/2007 |
| NPI Last Update Date: | 08/13/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251G0304X |
| License Number: | PT-1236 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Geriatrics |
| Taxonomy Definition: | |