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General NPI Number Information
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NPI Number | 1467850313
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Entity Type | Individual
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Provider Name | ANTONIO TREVINO
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Gender | Male
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Dates
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Enumeration Date | 12/09/2014
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Last Update Date | 12/09/2014
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Provider Practice Location Address
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Address Line | 305 5TH ST
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City | FARWELL
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State | TX
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Zip | 79325-5615
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Country | US
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Telephone | 888-873-4221
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 890
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City | FARWELL
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State | TX
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Zip | 79325-0890
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Country | US
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Telephone | 888-873-4221
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1160640
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License Number State | TX
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