Provider Demographics
NPI:1942853320
Name:TROTTY, BRYAN ALFORD (MS, LAT)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:ALFORD
Last Name:TROTTY
Suffix:
Gender:M
Credentials:MS, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 BOULDER LN
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-7002
Mailing Address - Country:US
Mailing Address - Phone:409-363-4005
Mailing Address - Fax:
Practice Address - Street 1:4310 APPLEBY SAND RD
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-2299
Practice Address - Country:US
Practice Address - Phone:936-564-2466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT55662255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer