MEDICARE: MANUEL ALESSIO TREVINO LMT

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	225700000X	Massage Therapist	MT132580	TX
2	111N00000X	Chiropractor	16117	TX

General Provider Information

NPI Number	:	1780334870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANUEL ALESSIO TREVINO LMT

Provider Business Mailing Address
First Line	:	5101 SQUAW CREEK CT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-3531
Country	:	US
Telephone Number	:	702-738-5374
Fax Number	:

Provider Business Practice Location Address
First Line	:	5101 SQUAW CREEK CT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-3531
Country	:	US
Telephone Number	:	702-738-5374
Fax Number	:

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

Provider Enumeration Date	:	03/24/2022
Last Update Date	:	07/12/2024

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