Healthcare Provider Details

I. General information

NPI: 1912128505
Provider Name (Legal Business Name): MATTHEW DUNCAN TRENT M.ED., ATC, LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 04/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 DENNIS CT
FRANKLIN TN
37067-5944
US

IV. Provider business mailing address

109 DENNIS CT
FRANKLIN TN
37067-5944
US

V. Phone/Fax

Practice location:
  • Phone: 615-400-1252
  • Fax:
Mailing address:
  • Phone: 615-400-1252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT0000000628
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: