Provider Demographics
NPI:1336382209
Name:TREVINO, SCOTT (PTA)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:TREVINO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1650 LYNDON FARM CT
Mailing Address - Street 2:SUITEM201
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5002
Mailing Address - Country:US
Mailing Address - Phone:502-412-5847
Mailing Address - Fax:502-412-0407
Practice Address - Street 1:1332 WATERFORD XING CIR
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-6009
Practice Address - Country:US
Practice Address - Phone:574-534-3920
Practice Address - Fax:574-533-1968
Is Sole Proprietor?:No
Enumeration Date:2009-04-08
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN06003409A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant