Provider Demographics
NPI:1275174682
Name:ENGLE, TREVOR DONALD (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:TREVOR
Middle Name:DONALD
Last Name:ENGLE
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 IDAHO AVE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50014-3767
Mailing Address - Country:US
Mailing Address - Phone:816-520-6372
Mailing Address - Fax:
Practice Address - Street 1:1921 AMES HIGH DR
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-5171
Practice Address - Country:US
Practice Address - Phone:816-520-6372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0929422255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty