Provider Demographics
NPI:1114819323
Name:TREK HOLDINGS INC
Entity type:Organization
Organization Name:TREK HOLDINGS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:DOUGHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:706-389-1260
Mailing Address - Street 1:2410 HOG MOUNTAIN RD STE 307
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-4850
Mailing Address - Country:US
Mailing Address - Phone:706-389-1260
Mailing Address - Fax:706-786-0797
Practice Address - Street 1:2410 HOG MOUNTAIN RD STE 307
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-4850
Practice Address - Country:US
Practice Address - Phone:706-389-1260
Practice Address - Fax:706-786-0797
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TREK HOLDINGS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier