MEDICARE: CHARLENE A TRINIDAD PT

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
1	225100000X	Physical Therapist	1180523	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1180523	OTHER	TX	PT LICENSE

General Provider Information

NPI Number	:	1578996351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLENE A TRINIDAD PT

Provider Business Mailing Address
First Line	:	520 BIRDSONG DR
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-2548
Country	:	US
Telephone Number	:	832-260-8993
Fax Number	:	832-426-0299

Provider Business Practice Location Address
First Line	:	520 BIRDSONG DR
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-2548
Country	:	US
Telephone Number	:	832-260-8993
Fax Number	:	832-426-0299

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2013
Last Update Date	:	08/15/2013

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Directions to “ CHARLENE A TRINIDAD PT” Practice Location

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