Individual
MACY TREVILLIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
4800 S SAGINAW ST, FLINT, MI 48507-2677
(810) 275-9610
Mailing address
4800 S SAGINAW ST, FLINT, MI 48507-2677
(810) 275-9610
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
W240570098371
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W240570098371
STATE OF MICHIGAN LICENSE
MI
Enumeration date
11/17/2020
Last updated
11/17/2020
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