Provider Demographics
NPI:1366261729
Name:TREVINO, ABIGAIL (MT)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:TREVINO
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17100 GLENMOUNT PARK DR STE C
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4368
Mailing Address - Country:US
Mailing Address - Phone:281-486-1675
Mailing Address - Fax:
Practice Address - Street 1:17100 GLENMOUNT PARK DR STE C
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4368
Practice Address - Country:US
Practice Address - Phone:281-486-1675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-03
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT140008225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist