Provider Demographics
NPI:1558841635
Name:TREVINO, MIGUEL (PTA)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:
Last Name:TREVINO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 INCARNATE WORD AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-6176
Mailing Address - Country:US
Mailing Address - Phone:956-648-3580
Mailing Address - Fax:
Practice Address - Street 1:1816 INCARNATE WORD AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-6176
Practice Address - Country:US
Practice Address - Phone:956-648-3580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-17
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2053363225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant