Healthcare Provider Details

I. General information

NPI: 1821530270
Provider Name (Legal Business Name): TROY DANIEL HOLLAND MAT, LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2016
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7942 CALIFORNIA AVE BAY 3
FORT CAMPBELL KY
42223-5515
US

IV. Provider business mailing address

727 ACORN DR
CLARKSVILLE TN
37043-2613
US

V. Phone/Fax

Practice location:
  • Phone: 270-798-8400
  • Fax:
Mailing address:
  • Phone: 909-731-5940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2573
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000023670
License Number State
# 3
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number729339
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: