Provider Demographics
NPI:1225578339
Name:TREVINO, TRISTEN (ATC)
Entity type:Individual
Prefix:
First Name:TRISTEN
Middle Name:
Last Name:TREVINO
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6607 BRODIE LN
Mailing Address - Street 2:APT 1116
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-4658
Mailing Address - Country:US
Mailing Address - Phone:830-879-5157
Mailing Address - Fax:
Practice Address - Street 1:6607 BRODIE LN
Practice Address - Street 2:APT 1116
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-4658
Practice Address - Country:US
Practice Address - Phone:830-879-5157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX#AT52612255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer