Provider Demographics
NPI:1033711783
Name:LAND, TRENTEN JAMES
Entity Type:Individual
Prefix:
First Name:TRENTEN
Middle Name:JAMES
Last Name:LAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15860 FOREST LAKE DR
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-8671
Mailing Address - Country:US
Mailing Address - Phone:567-250-0202
Mailing Address - Fax:
Practice Address - Street 1:15860 FOREST LAKE DR
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-8671
Practice Address - Country:US
Practice Address - Phone:567-250-0202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer