Provider Demographics
NPI:1316075922
Name:TREJO, MARCUS WAYNE (PT)
Entity type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:WAYNE
Last Name:TREJO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2107 FARMSVILLE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-1942
Mailing Address - Country:US
Mailing Address - Phone:210-593-0510
Mailing Address - Fax:210-593-0633
Practice Address - Street 1:102 PALO ALTO RD
Practice Address - Street 2:SUITE 465
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78211-3758
Practice Address - Country:US
Practice Address - Phone:210-593-0510
Practice Address - Fax:210-593-0633
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1046449225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T8140OtherBCBS OF TEXAS
TX161969402Medicaid
TX8K6689Medicare PIN