Provider Demographics
NPI:1033175070
Name:TREVILLIAN, SANDRA (PT)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:TREVILLIAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5303 E CALLE DE BACA
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-5561
Mailing Address - Country:US
Mailing Address - Phone:252-312-6338
Mailing Address - Fax:
Practice Address - Street 1:9917 N 95TH ST STE P
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4586
Practice Address - Country:US
Practice Address - Phone:480-314-1553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305002463225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010179513Medicaid
7603693OtherAETNA
VAP00274855OtherRAILROAD MEDICARE
VA192941OtherBCBS PHYSICAL THERAPY
VA010179513Medicaid
VA008025T54Medicare PIN