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Individual

MS. AMY JEANETTE TREVINO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MPT

Contact information

Practice address
9514 GRAVELLY LAKE DR SW, LAKEWOOD, WA 98499-1514
(253) 983-9395
(253) 983-9411
Mailing address
9315 GRAVELLY LAKE DR SW, SUITE 306, LAKEWOOD, WA 98499-1574
(253) 581-5200
(253) 581-5203

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT60318927
WA
2251X0800X
Orthopedic Physical Therapist
1127629
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0319928
WA L&I PROVIDER NUMBER
WA
Enumeration date
11/11/2005
Last updated
04/14/2014
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