Provider Demographics
NPI:1821530270
Name:HOLLAND, TROY DANIEL (MAT, LAT, ATC)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:DANIEL
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:MAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 ACORN DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-2613
Mailing Address - Country:US
Mailing Address - Phone:909-731-5940
Mailing Address - Fax:
Practice Address - Street 1:7942 CALIFORNIA AVE BAY 3
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5515
Practice Address - Country:US
Practice Address - Phone:270-798-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-15
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25732255A2300X
20000236702255A2300X
TX729339146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic