Trevis Lee Trevino

Primary specialty

Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X

License

T615802497876 Issued in MI

Practice address

1851 44TH St SW Ste a
Wyoming, MI 49519-6440

Phone

(616) 538-4400

NPI assigned

Aug 28, 2015

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 6

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1440720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660348800000",
    "number": "1285001842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 FAIRMOUNT ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495061555",
            "telephone_number": "310-625-9373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1851 44TH ST SW STE A",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495196440",
            "telephone_number": "616-538-4400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2000 Burton St SE # 1",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495064670",
            "country_code": "US",
            "telephone_number": "616-608-8485",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "915 Fairmount St SE",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495061555",
            "country_code": "US",
            "telephone_number": "616-432-1444",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "242 52nd St SE",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495485829",
            "country_code": "US",
            "telephone_number": "616-538-7460",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1643 Sunny Creek St SE",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495084968",
            "country_code": "US",
            "telephone_number": "616-432-1444",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TREVINO",
        "first_name": "TREVIS",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-08-28",
        "last_updated": "2022-08-13",
        "certification_date": "2022-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": "MI",
            "license": "3019283855",
            "primary": false
        },
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": "CA",
            "license": "1849503021",
            "primary": false
        },
        {
            "code": "2081S0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": "CA",
            "license": "TT37598187",
            "primary": false
        },
        {
            "code": "2083S0010X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Sports Medicine",
            "state": "CA",
            "license": "TT37598187",
            "primary": false
        },
        {
            "code": "2083S0010X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Sports Medicine",
            "state": "MI",
            "license": "T615802497876",
            "primary": false
        },
        {
            "code": "2081S0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": "MI",
            "license": "T615802497876",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Loan Tran
• Diane Sue Traver, R.D. PH.D. C.D.E.
• Amanda Rose Travis, MSPT
• Faith Treat, M.A., CCC-SLP
• William D Tressel, D.O.
• Melanie Trinh, PHARMD
• Linh Phuong Truong
• Demetrios Tsirukis
• Kirsten Tucker, DO
• Brandon Turcotte

• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Wyoming, MI
• Providers in Wyoming, MI by specialty
• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.