Provider Demographics
NPI:1477440220
Name:MEDTREV ENTERPRISE, PLLC
Entity type:Organization
Organization Name:MEDTREV ENTERPRISE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LIANA
Authorized Official - Middle Name:RACHEL
Authorized Official - Last Name:TREVINO
Authorized Official - Suffix:
Authorized Official - Credentials:PPOT, OTR, CLT
Authorized Official - Phone:210-216-4969
Mailing Address - Street 1:153 LOU JON CIR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-3354
Mailing Address - Country:US
Mailing Address - Phone:210-216-4969
Mailing Address - Fax:
Practice Address - Street 1:634 S PRESA ST STE 1
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78210-1067
Practice Address - Country:US
Practice Address - Phone:210-216-4969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty