Healthcare Provider Details

I. General information

NPI: 1790817070
Provider Name (Legal Business Name): TROY LYNN ROBERTS ATC, LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S CHERRY LN
WHITE SETTLEMENT TX
76108-3215
US

IV. Provider business mailing address

1630 PALASADES DR 1113
FORT WORTH TX
76108-7929
US

V. Phone/Fax

Practice location:
  • Phone: 817-367-1200
  • Fax:
Mailing address:
  • Phone: 817-739-7302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT2153
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: