Provider Demographics
NPI:1477596963
Name:HOLMAN, TREVOR D (ATC)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:D
Last Name:HOLMAN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14655 KASEL CT NE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:OR
Mailing Address - Zip Code:97002-9445
Mailing Address - Country:US
Mailing Address - Phone:503-789-4221
Mailing Address - Fax:
Practice Address - Street 1:3303 SW BOND AVE MAIL CODE: CH3T
Practice Address - Street 2:OREGON HEALTH & SCIENCES UNIVERSITY
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239
Practice Address - Country:US
Practice Address - Phone:503-418-2406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAT-AT-7501702255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer