Provider Demographics
NPI:1346082419
Name:STREM, TREVOR BLAKE (PT, DPT)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:BLAKE
Last Name:STREM
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 NE 2ND ST UNIT 1322
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-4746
Mailing Address - Country:US
Mailing Address - Phone:503-770-0352
Mailing Address - Fax:
Practice Address - Street 1:1445 NE MILLER ST STE 3A
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-8460
Practice Address - Country:US
Practice Address - Phone:503-770-0352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR65180225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist