=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104451624
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TREVOR JAMES LOYD MS, LAT, ATC, CES
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2020
-----------------------------------------------------
Last Update Date | 07/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 777 W HARRISBURG PIKE
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17057-4898
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-421-1727
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4929 HAMILTON DR
-----------------------------------------------------
City | HARRISBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17109-3211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-421-1727
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | RT007010
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------