Provider Demographics
NPI:1982184446
Name:TREVINO, ANTONIO (PTA)
Entity Type:Individual
Prefix:
First Name:ANTONIO
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 1:4107 W MILE 171/2 RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541
Mailing Address - Country:US
Mailing Address - Phone:956-393-8504
Mailing Address - Fax:
Practice Address - Street 1:422 E 18TH ST
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-8032
Practice Address - Country:US
Practice Address - Phone:956-973-8451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2012803225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant