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General NPI Number Information
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NPI Number | 1477440220
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Entity Type | Organization
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Legal Business Name | MEDTREV ENTERPRISE, PLLC
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Dates
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Enumeration Date | 06/23/2025
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 634 S PRESA ST STE 1
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City | SAN ANTONIO
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State | TX
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Zip | 78210-1067
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Country | US
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Telephone | 210-216-4969
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Fax |
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Provider Business Mailing Address
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Address Line | 153 LOU JON CIR
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City | SAN ANTONIO
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State | TX
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Zip | 78213-3354
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Country | US
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Telephone | 210-216-4969
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LIANA RACHEL TREVINO
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Credential | PPOT, OTR, CLT
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Telephone | 210-216-4969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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