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NPI Code Detail

MEDICARE: MS. AMY JEANETTE TREVINO MPT

MEDICARE: MS. AMY JEANETTE TREVINO MPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12251X0800XOrthopedic Physical Therapist1127629TX
2225100000XPhysical TherapistPT60318927WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10319928OTHERWAWA L&I PROVIDER NUMBER

General Provider Information

NPI Number : 1679554935
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. AMY JEANETTE TREVINO MPT
Provider Business Mailing Address
First Line : 9315 GRAVELLY LAKE DR SW
Second Line : SUITE 306
City : LAKEWOOD
State : WA
Zip : 98499-1574
Country : US
Telephone Number : 253-581-5200
Fax Number : 253-581-5203
Provider Business Practice Location Address
First Line : 9514 GRAVELLY LAKE DR SW
Second Line :
City : LAKEWOOD
State : WA
Zip : 98499-1514
Country : US
Telephone Number : 253-983-9395
Fax Number : 253-983-9411
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/11/2005
Last Update Date : 04/14/2014

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